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862768fa-36ea-4f23-802a-07ca10e5572b Social Prescribing Link Workers framework: supporting complex needs of adults living with physical and mental health long term conditions Chief Investigators: Dr Leire Ambrosio. Lecturer. School of Health Sciences, University of Southampton and Mari Carmen Portillo. Professor of Long-term Conditions. School of Health Sciences, University of Southampto. Team: Skaiste Linceviciute. Research Fellow. Faculty of Medicine, University of Southampton, David Baldwin. Professor of Psychiatry and Section Head, Clinical Neuroscience, Faculty of Medicine, University of Southampton Joseph Jenness. Senior Manager at Southampton Voluntary Services. SO:Linked Jade Topham. Social Prescribing Link Worker, Southampton North PCN William Barnaby Jones. NIHR ARC Wessex PPIE, University of Southampton Traci Carroll. PPIE Representative as part of the NIHR ARC Wessex PPIE group, University of Southampton Siân Brand. Chair of Social Prescribing Network, Social Prescribing Network Partners: Hampshire and Isle of Wight Integrated Care Board, Hampshire and Isle of Wight NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust, University of Southampton, Anxiety UK, Social Prescribing Network, SO: Linked. Start: 1 October 2024 End: 31 March 2026 Background to the research As part of the NHS Long Term Plan in rolling out an integrated approach built around personalised care, NHS England has initiated the Social Prescribing Link Workers (SPLW) model to offer personalised support for patients in primary care facing continued pressures with long-term conditions, and to bridge fragmented healthcare systems with key community stakeholders through joined-up approaches (NHS, 2019). Our recent SPLW project demonstrated that despite Link Workers’ positive and multifaceted impact, the current efforts lack standardised approach and robust guidance that delay and complicate the work of SPLWs in delivering coordinated support for addressing the needs of adults with long-term physical and mental health conditions. Key challenges related to the lack of collaborative planning, expectations management, and limited communication with multidisciplinary teams. This leaves SPLWs managing complex cases with overstretched workload and with patients struggling to achieve sustainable, long-term support for the management of their physical and mental health LTCs. Aims of the research Informed by the findings of our previous SPLW project, a need has emerged to develop a consistent SPLW framework that sets out sustainable and integrated pathway that can optimise social prescribing services in the community, standardise guidance for training support and is equipped to support the long-term management of complex needs of adults with physical and mental health LTCs. Publications Understanding the potential role of Social Prescribing Link Workers in supporting identified needs of people with physical and mental long-term conditions: a qualitative study | BMC Primary Care | Full Text

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

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

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

be5aaf78-5349-4834-a57a-fcddffbfb962 GOODNIGHT Covid-19 to care-home-based vulnerable individuals Novel corona virus (COVID-19) is a virus that has spread quickly around the world. Elderly people with other health problems have a high death rate from the infection. There are no treatments for COVID-19 so prevention of infection is very important. COVID-19 is thought to infect people via the nose and mouth. Current best practise to prevent infection focuses on good hand hygiene, the wearing of masks and by limiting social contact. However, elderly people in care homes have to come into contact with staff members who are looking after them. Hypertonic saline nasal irrigation and gargling (HSNIG) has been shown to reduce the viral load of coronaviruses and has potential to reduce Covid-19 transmission in a community setting. The objective of this trial is to assess the feasibility and acceptability of care home staff adopting this technique. This research has now been submitted for publication. If you would like to know more about this study please contact Dr Ryan Buchanan Co-Chief investigators Dr Thomas Daniels, Consultant Respiratory Physician, Honorary Senior Clinical Lecturer, University of Southampton Dr Ryan Buchanan, Academic Clinical Lecturer, Primary Care, Population Science and Medical Education, University of Southampton Partners: University Hospital Southampton NHS Foundation Trust, Southampton CTU & NIHR ARC Wessex Co-applicants Professor Julie Parkes, Professor of Public Health, University of Southampton Professor Helen Roberts, Professor of Medicine for Older People, University of Southampton Emeritus Professor Jeremy Wyatt – University of Southampton Dr Beth Stuart – Medical Statistician, Southampton Clinical Trials Unit Dr Kinda Ibrahim - Senior Research Fellow, Faculty of Medicine, University Hospital Southampton NHS Foundation Trust Dr Andrew Cook – Public Health Consultant, Fellow of Health Technology Assessment, University of Southampton See the training video for Care Home staff: https://www.youtube.com/watch?v=__-QSLlGWps Publications http://dx.doi.org/10.14283/jnhrs.2021.3

ff477b29-43df-41e3-8562-aeeb2cfcbef7 ADOPTED: Investigating Quality of Care for People with Dementia Undergoing Cancer Treatment in Ambulatory Care (ImPaCT) Principal Investigator: Dr Naomi Farrington Team members: Dr Naomi Farrington (Advanced Nurse Practitioner and NIHR Clinical Lecturer, University Hospital Southampton and University of Southampton), Professor Jackie Bridges (Professor of Older People’s Care, School of Health Sciences, University of Southampton), Professor Alison Richardson (Clinical Professor of Cancer Nursing and End of Life Care, University of Southampton and University Hospital Southampton). Start: 01 January 2019 End: 31 May 2022 Project partners: University Hospital Southampton NHS Foundation Trust, University of Southampton. S tudy is funded as part of a HEE/NIHR Clinical Lectureship Lay summary: There is not much information about people with dementia having cancer treatment. This study aims to understand how high quality care can be provided for people with dementia undergoing outpatient cancer treatment (radiotherapy, chemotherapy or other anti-cancer treatment). The study uses a research method called ethnography, which is where a researcher conducts ‘fieldwork’ to study a group of people to better understand that group. It will look at: The environment (surroundings and conditions) of the outpatient clinics and treatment areas; How people in the outpatient clinics and treatment areas behave and interact with each other; How treatment and support is organized in the outpatient clinic and treatment areas. Fieldwork will take place in the outpatient departments of University Hospital Southampton NHS Foundation Trust. It will include observations, interviews and review of patient notes. The people who will be invited to take part in the study are: People with dementia having cancer treatment; Friends or family supporting people with dementia having cancer treatment; Staff involved in the care of people with dementia having cancer treatment (doctors, nurses, support workers, administrative staff, and others). All those who take part in the study will be asked to give consent. The study includes: Observation . this will be carried out in cancer outpatient clinics and treatment areas. This will look at the environment (surroundings and conditions); the everyday interactions that happen between patients, carers and staff; and way in which care and support take place. Observation will take place in the general clinic areas as well as during doctor appointments and when treatment is being given. The researcher will take detailed notes. Interviews . these will be carried out with patients, carers and staff. These will focus on how people in the study speak and act to understand more about how they think and feel. Interviews will be digitally recorded, and a written transcript will be made. Patient notes . Researchers will look at patient notes to add to the information from observation and interviews. They will look at the notes to find out about diagnosis, treatment and support offered to patients. These 3 methods of data collection will help the researchers put together a detailed picture of the outpatient setting including how people act ( behaviour ), the surroundings and conditions ( environment ), and the way treatment and support is organised ( processes ). This will reveal ways in which healthcare organisations might best provide cancer treatment for people with dementia that is person-centred (focused on the needs of the person themselves) and of a high quality. What did we learn? The cultural environment of the outpatient care setting reflects and supports the standardized processing of people for cancer treatment. Dementia introduces a wider set of care requirements not catered for by a standardized treatment model. The needs of patients with dementia could be addressed most effectively when individualized care, was offered. This was possible when services were responsive to patient need. What difference did this new knowledge make? Outpatient cancer services can ensure responsiveness by: having an established way of eliciting needs, preferences and expectations a belief that a person's needs and expectations are legitimate, and that effort should be made to address them ability to accommodate these needs and expectations. Why is this important for patients, health and care providers, and policy makers? Managers of outpatient cancer care services have a better understanding of how to design and organize settings so that the needs of people with dementia can be addressed. Patients with dementia and their families will be more likely to receive personalized care that meets their needs. Policy makers will be more aware of the need to incorporate principles of personalized care into policies guiding the care and treatment of people with multiple health conditions. What have we done? This work has been part of building momentum to increase the profile of how people with cancer and dementia receive care and treatment. A national symposium was carried out with clinicians and academics in 2022 showcasing work addressing cancer and dementia. Dr Naomi Farrington is presenting this work as part of a session on ‘Person-Centred Care’ at the European Oncology Nursing Society in Madrid, October 2023. 3 papers have been published on this study: Understanding the cultural environment of the outpatient care setting for patients with dementia receiving cancer treatment: a qualitative study. https://pubmed.ncbi.nlm.nih.gov/36382351/ How can I improve cancer services for people with dementia? https://journals.rcni.com/cancer-nursing-practice/evidence-and-practice/how-can-i-improve-cancer-services-for-people-with-dementia-cnp.21.5.22.s10/full 'A rea l fine balancing act’: A secondary qualitative analysis of power imbalance in comorbid cancer and dementia in an outpatient treatment setting. https://pubmed.ncbi.nlm.nih.gov/36929372/ C LEAR steps for a responsive outpatient cancer service • C larify needs, expectations, preferences and goals • L egitimise these as valid • E nable these to be met by implementing strategies • A udit to ensure this is working for patients caregivers and health service • R ecord for the future https://vimeo.com/688041079

40fed7f8-d8d0-46f4-80c3-660e33675330 PIVOT: Promoting Increased physical actiVity in hospitalised Older adults with Trained volunteers NIHR Advanced Fellowship Award: Dr Stephen Lim, Honorary Consultant Geriatrician University Hospital Southampton NHS Foundation Trust and Principal Clinical Research Fellow, University of Southampton Team : Dr Samantha Meredith Research Fellow, University of Southampton, Professor Beth Stuart Clinical Trials Co-director of the Pragmatic Trials Unit, Queen Mary University of London, Professor Carl Thompson Applied Health Research, University of Leeds Aim(s) of the research To determine whether hospital volunteers can be trained to engage older people in hospital to be more active. We want to know if this intervention will work in different hospitals and explore factors that will support or prevent it from being delivered successfully. Background to the research Between 30 and 60% of older people in hospital are at risk of losing muscle strength and function, known as deconditioning. This reduces their ability to look after themselves independently. Low physical activity level contributes to deconditioning but dedicated physical activity sessions can benefit older inpatients. In most studies, physical activity is led by paid staff. New ideas are needed to ensure additional physical activity sessions are costeffective and sustainable. The Southampton Mobility Volunteer study showed that trained volunteers can safely engage older inpatients to be more active. However, more information is needed on how to make this approach accessible to more people in more hospitals. Design and methods used Hospital inpatients aged 65 years and older will be invited to participate in the study. We will conduct the study in four hospitals. The hospitals will be different in size and from a wider region to include a range of population groups from different settings and context. This is so that different social groups are represented, and the research will be more representative of the wider population. We will use one hospital as a ‘control site’ – where patients will not get volunteer input – to compare our findings against. Volunteers will encourage participants who can walk independently to walk twice daily. Patients who need help with walking will do bedside exercises. They will be encouraged to walk once they can do so independently. We want to know whether trained volunteer delivered exercise sessions are feasible and acceptable to hospitals. We will determine this by collecting data on volunteer recruitment and training, patient recruitment and the walking/ exercises intervention. We will interview patients, staff, and volunteers as the intervention is delivered to establish what worked well and what could be improved. Other outcomes will include physical abilities, muscle strength, length of stay and readmission rates. We will analyse how much money it costs the NHS to deliver the intervention. Patient/service user, carer and public involvement The James Lind Alliance Priority Setting Partnership has highlighted promoting of independence, and physical and emotional well-being as 2 of the top 3 key research priorities for older adults. More specifically, our PPI research with 92 older people showed that 45% of them had experience with hospital volunteers and all spoke highly of their contribution. Most respondents thought volunteers could be trained to help with mobility. My feasibility study (SoMoVe study) confirmed the volunteer-led intervention was acceptable to patients, volunteers, and staff in one hospital. Patients were grateful that the volunteers encouraged them to be more active. Staff members valued the work of the volunteers. This proposal was developed with the support of 2 public researchers, the volunteer services manager and a hospital therapy lead. The study protocol and study documents will be developed with PPI collaboration. 2 public researchers will be invited to join the study steering group. PPI input will be paid at INVOLVE rates. Dissemination Findings from this study will be shared through conferences, academic papers/reports, and media/social media. In collaboration with the Academic Health Science Network, we will share our findings with commissioners, providers of care and voluntary organisations. Study findings will be of interest to voluntary services, healthcare professionals, and directorate managers. A collection of resources will be produced to encourage the adoption of this intervention in other settings.

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.

Vikki Tweedy is an Advanced Nurse Practitioner (Dementia/Frailty) Dorset County Hospital NHS Foundation Trust - and is about to begin a PhD at Bournemouth University < Back Caring for the person with dementia in hospital Veterans and Dementia - why routines can matter Vikki Tweedy is an Advanced Nurse Practitioner (Dementia/Frailty) Dorset County Hospital NHS Foundation Trust - and is about to begin a PhD at Bournemouth University Dementia is a progressive condition affecting cognition, memory, and behaviour, with significant implications for individuals, families, and healthcare providers. Patients with dementia are highly vulnerable in hospital environments due to unfamiliar surroundings, disrupted routines, and communication difficulties. This can lead to increased anxiety, agitation, and a decline in physical and cognitive function. The traditional hospital model, which prioritises medical interventions over psychological and emotional well-being, often fails to meet their holistic needs. Therapeutic engagement involves structured, person-centred interactions that promote communication, emotional well-being, and cognitive stimulation. Rather than focusing solely on physical care, it aims to build trust, reduce distress, and enhance the overall hospital experience. While medical management is essential, therapeutic engagement and meaningful activity play a crucial role in improving patient well-being and hospital experience and here Dorset County Hospital NHS Foundation Trust the Dementia team have taken a proactive approach to try to address the personalised need for activity. Meaningful activity refers to engagement that holds personal significance to an individual. For people with dementia, maintaining a sense of routine and purpose through tailored activities can significantly enhance well-being. Through engagement with veterans with dementia in acute hospital setting, I have observed first hand how their military backgrounds influence their hospital experiences, responses to stress, and engagement with care teams. Meaningful activity is particularly relevant for veterans with dementia, whose unique life experiences, military backgrounds, and potential trauma histories require a tailored approach to care. Understanding their needs and providing structured engagement can help mitigate distress, improve outcomes, and foster a sense of purpose during hospitalisation. For veterans with dementia, the challenge of the hospital environment can be further compounded by their past experiences. Military training emphasises structure, discipline, and resilience, which may shape how veterans respond to hospitalisation. Additionally, some veterans may have underlying post-traumatic stress disorder (PTSD) or other service-related mental health conditions that can influence their reactions to stress, noise, and certain interactions. Without appropriate engagement strategies, they may experience heightened distress, mistrust, or withdrawal. Having completed an NIHR internship (research initiation award), this gave me confidence and knowledge to want to pursue a clinical academic pathway and my work in this area has now led me to progress a proposal for a PhD, focusing on the lived experience of veterans with dementia in the acute hospital setting, further highlighting the importance of personalised, meaningful interventions in acute care settings. It is hoped that this research will contribute to improving care pathways for veterans with dementia, ensuring they receive hospital care that recognises and respects their unique needs. Therapeutic engagement and meaningful activity are essential components of high-quality dementia care in NHS acute hospitals. For veterans with dementia, recognising and integrating military-specific approaches can further enhance their hospital experience, reduce distress, and promote better outcomes. Embedding these principles into routine practice requires staff training, investment in resources, and collaboration with military support organisations. Here at Dorset County Hospital we have also been extremely fortunate to have been supported by the Royal British Legion who have provided us with some care packages to give to veterans in the hospital. The giving of the care packages by the dementia team was an excellent way to engage with patients about their military history but also to give the recognition to those who have served. Previous Next

283829ae-0e8e-40ad-96e6-9c01fa950327 SOCIAL CARE: Local Authority Adult Social Care Recruitment and Retention research project (BCP/Dorset) Lead: Dr Andy Pulman Post Doctoral Researcher and Professor Lee-Ann Fenge Contact: apulman@bournemouth.ac.uk Background Within the Wessex region, we have been working to support the development of social care research over the past few years. In 2022, we completed a year-long study examining social care research enablers and barriers which might prevent or limit a positive research environment for practitioners ( Pulman and Fenge, 2023 ). This built the foundation for four projects across Wessex – funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) Wessex – which aimed to build research partnerships across local authorities (LAs) and universities in the region. As part of these projects, separate funding was available to support research champions embedded within local authorities, to support activities such as lunch time research discussions, journal clubs and the development of practitioner focused research. To encourage buy-in from the LAs we developed research in partnership with them to respond to key priority areas. Aims The aims of our project were: •Explore local recruitment and retention issues in adult social care and adult social work •Helping to inform future workforce development activities undertaken by two local authorities (LAs) •Contributing research data to both the regional and national picture of adult social care recruitment and retention issues How did we do this? Data for our project was collected between February 2023 and October 2023 and explored local recruitment and retention issues in Adult Social Care (ASC) from the perspective of four populations of interest. We collected data from n=131 participants across the four populations of interest: •Social care practitioners - social workers, allied health professionals, unregistered social care practitioners - working in adult social care at two local authorities (LAs) •Social care staff performing exit interviews with staff working in the two local LAs •Social work students (undergraduate and postgraduate programmes) in Wessex •Service users receiving services in either LA and advocates drawn from Wessex LA contracted services es Pos Positive Outcomes • Practitioner demand to participate in this study was very high and we exceeded our initial recruitment targets. • Being able to shine a light on some of the current issues facing advocacy – a currently under-reported research area – as a part of our qualitative data collected from POI 4 was an enlightening and beneficial bonus. • Being able to involve and co-write with both the PPI collaborator and the two research champions from a local authority to produce two separate academic articles from the project was another highlight. • Reaching a national newspaper (both print and online in the Telegraph) with research findings from practitioners regarding hybridization and hotdesking was a very positive development in reaching an external audience. Practioner findings - Data on Staying Reasons for staying with LAs included: • Flexible working – place of work and hours worked • Love of the job and engaging with the service users supported • Supportive management • Supportive team • Training and CPD - via continuing professional development or an apprenticeship. A number of outputs from this project can be viewed below. We have also submitted a number of journal articles describing findings from the project data to the peer review process, which will hopefully be available later this year. Practioner Challenges Challenges to Retention highlighted include: Hybridisation and Hot desking Stress and Burnout Negative Perceptions of Social Care Student Reflections on Social Care • There is always focus on recruitment, but not on retention. • Social care is hugely underfunded but money is not the only answer –a place where people want to be. • Awareness that SW not seen as a fully sustainable career. Some already planning exit strategies before they started work - a perceived shelf life for a social work career. • Worries about excessive caseloads/increased admin burdens and bureaucracy. • Pay level was deemed inadequate for the demands of the job. • On placement students noticed issues with team churn, attrition and a lack of stability – one had 8 different managers over a 12 months. • Staff shortages – some vacancies can’t even be filled by locums. • COVID-19 had been the prompt for a lot of staff to move on. • Agency usage is an issue (for example, out of county managers). This is helping to create a ‘perfect storm’. • Risk of stress and burnout inherent in profession was noted: Ethical Dilemmas / Job related / Questioning of their decision making / Resilience / Coping strategies / Travel issues Students reflected on Cost of Linving Impacts that: • Increased numbers seeking hardship support / more working alongside study • Social work bursaries frozen since 2014 – more earning whilst learning • Some HEI staff do not appreciate hardships experienced or demands faced • Burnout - feeling stressed/lacking in energy after working full-time alongside course. • Longer term, reductions in students entering the profession have major implications for meeting rising level of vacancies in social work. • Cost of living issues an increasingly influential factor for prospective students when choosing route/retraining as mature student. Service User reflections on Social Work Relationships • Changing role - onus now on the carer more to be the lead professional though not through choice. • Biggest issue is lack of money in the system. • Money over empathy – it often feels like carers and SUs cost money. • Inertia - one participant described this feeling as : “It doesn't matter how I am, you're not going to do anything about it”. • Whole structure needs an overhaul. Social work/social care is a societal issue and priority Service User reflections on staff turnover • Previous continuity of same worker no longer exists. Rapid changeover / staffing issues causing upset for carers and SUs. • Churn obliterates previous working relationships • Depersonalisation – team rather than individual; now you don’t usually have a designated social worker. It's a group. • Less frequent contact. • Out-of-hours - service is overstretched and doesn’t cover the whole area effectively for time precious situations. Impact on Advocates · Safeguarding caseloads for advocates have increased. Crisis situations due to lack of early intervention. After discharge there is no pick-up or continuity from the community – loss of advocate, a new LA social worker or unqualified social care practitioner assigned, or the case is closed as it is classified as ‘not in crisis’. · Increased caseloads now have greater complexity. There are more Section 21A challenges – a review under a Deprivation of Liberty Safeguards (DoLS) as SUs unable to care package in the community. · Community advocacy - which prevents crisis in a lot of cases - has been reduced as statutory work always comes first. SUs need be in receipt of an LA commissioned service or NHS secondary care before they can get issues-based advocacy. · Increased complexity causes settled cases to be visited less regularly as advocates now deal with more complex court proceedings and safeguarding issues. Increased caseloads - Social work / NHS overflow · Social work seems to be moving away from relationship-based practice to procedurally driven form-filling with advocates picking up some of this work instead. · “ Hold on, this is not actually my role” - Advocates are doing part of the social worker’s job because, for whatever reason, they are not able to. · There is a greater expectation of monitoring conditions done by the supervising body, when actually it’s not their role as an advocate, but it has become their role. · Less time for IMHA within hospitals as advocates now have little or no time to do it. Further reading – blogs: A blog for World Social Work Day (19/03/24) Further reading – reports: Recruitment and retention in adult social care Executive Summary. Bournemouth: NCCDSW, Bournemouth University. Recruitment and retention in adult social care. Bournemouth: NCCDSW, Bournemouth University. Further viewing: NIHR ARC Wessex Social Care Lunchtime Seminar – Realities of adult social care recruitment and retention in 2023 (18/01/24) Publications Full article: Advocacy in Practice: Who Advocates for the Advocates? Evolving Workplace: The Possible Impacts of Hybrid Working and Hotdesking on Retention of Social Workers | The British Journal of Social Work | Oxford Academic Full article: Impacts of Workplace Stress on the Retention of Social Workers: A Qualitative Study Full article: Struggling with studying and earning – realities of the UK's cost-of-living crisis on students on social work programmes

Senior Research Assistant < Back Gabrielle Palermo Senior Research Assistant Ageing and Dementia Gabrielle Palermo is a Senior Research Assistant at the NIHR ARC Wessex Mental Health Hub, University of Southampton. She supports quantitative research on alcohol use disorder in older adults and contributes to other Hub projects involving complex routine datasets, including the OLA study. With over 20 years of experience in applied statistics, Gabrielle specialises in quantitative methods for epidemiological, socioeconomic, and public health research, particularly in the analysis of survey and administrative data. Her expertise includes multilevel modelling, complex survey design for cross-sectional and longitudinal data, data cleaning and linkage, and the treatment of missing data. She holds an MSc in Population Studies and a BSc in Statistics from ENCE–IBGE (Brazil). Her doctoral research focuses on statistical methodologies for unbalanced longitudinal data in sample-based educational panel studies, with emphasis on school effectiveness and pupil mobility. Since 2022, she has worked across multiple departments within the Faculty of Medicine at the University of Southampton, contributing to research in epidemiology and clinical trials. Previous Next