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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 .

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

e468f3be-ad28-42e2-8ec5-7270d68258c8 ADOPTED: Treatment burden in people below the age of 65 with multimorbidity in primary care: A mixed methods (SPELL) Principal Investigator: Dr Rachel Johnson, University of Bristol Team: Prof Chris Salisbury, University of Bristol Prof Jose Valderas, University of Exteter Dr Simon Fraser, Univeristy of Southampton Dr Maria Panagioti, University of Manchester Dr Tom Blakeman, Univeristy of Manchester Dr Shoba Dawson, University of Bristol Dr Polly Duncan, University of Bristol Dr Michael Lawton, University of Bristol Start Date: 1 February 2022 End Date: 31 July 2024 Background One in two people over the age of 50 have more than one long term health condition (multimorbidity). The number of people living with multimorbidity is growing. Compared with people without multimorbidity, people with multimorbidity have worse quality of life, take more medicines, and are more likely to die or to be admitted to hospital. More people in deprived areas develop multimorbidity at a younger age. As a group, people with multimorbidity have more contacts with healthcare services than people with one or no long-term conditions. Because of this the NHS and policy-makers want to find ways to manage multimorbidity better. People with multimorbidity put a lot of effort to manage their medicines and healthcare appointments (treatment burden). There is some research that younger people experience more treatment burden. Previous research tells us that sometimes it is the simple things like getting appointments with the GP and finding parking that cause the most burden. Although people with multimorbidity are often grouped together, their experience depends on the health conditions they have, their ethnicity, where they live and their level of income. People with multimorbidity who are working age might have different problems such as getting time off work for appointments, managing their health conditions as work, or juggling childcare. This study will focus on people who are under the age of 65, as not much research has focused on them. A recent report by a charity for people with multimorbidity said that not much research has been done on how it feels for people to live with multimorbidity. Also, we do not know the best way to support and treat people with multimorbidity in GP services. If we understand people’s experiences, we might be able to design better services to meet their needs. There are some questionnaires that could be used to find people who be finding it difficult to cope with their multimorbidity burden, but they need more testing in the UK, particularly in younger people. Some questionnaires are too long, and it would be helpful to have a short version (e.g. just one question). This could be used regularly, as a quick way to identify people who might be ‘overburdened’ and need more support. We want to find out how health care services can support people with multimorbidity and reduce their treatment burden. We will do this in three ways: 1) interviewing people with multimorbidity, 2) ask people to complete questionnaires and 3) hold a meeting with people with multimorbidity, GPs and people who organise GP services, to talk about what we have found and work together to make recommendations to improve care. Throughout the study, we will work with the staff and patients at the GP surgeries involved to increase the number of people who take part. We will make efforts to reach and include people from minority ethnic groups and those who have difficulties in accessing health care. We will work with local community groups to raise awareness about this study and translate study materials into different languages. People with multimorbidity who take part in each part of the study will receive a voucher to thank them for taking part. In the first part of the study, we will ask GPs to find people with multimorbidity at their practice. We will invite some of those people to be interviewed, for up to 1 hour, either by phone, video or face to face. During the interview we will find out about their experience of living with multimorbidity, efforts they have to put into managing their health and treatment burden, and ways in which using health care services help or make it more difficult. We will use what we find in this study to help design the questionnaire that we will use in the second part of the study. In the second part of the study, we will ask GPs to invite randomly selected people from their practice. People who agree to take part will fill in questionnaires and give us permission to look at their medical notes. The questionnaires will ask about their experiences of care, how multimorbidity affects them, including the burden because of their health conditions or from managing them. As part of this we will test how well a short measure, based on a very small number of questions or even a single question, works in identifying overburdened people. In the third part of the study, we will hold a meeting with patients, people who organise healthcare services, and commissioners and healthcare professionals. During this meeting we will make sense of the results from interviews and questionnaires to identify how health services can support people with multimorbidity We will work together with people with multimorbidity or those with experience of caring for people with multimorbidity. The idea for this study came from a PPI group focused on multimorbidity research projects, with which both RJ and SC have been involved in for the past two years. We have set up a patient and public involvement (PPI) group including six people (two from minority ethnic groups). This group will be involved throughout the study from developing study materials to developing materials for sharing study findings.

3020cd35-d002-4b24-bc53-5ac051771722 Adopted Project: Paramedic delivery of end-of-life care (PARAID) Study Chief Investigator: Dr Natasha Campling, University of Southampton Funder: Marie Curie Research Grants Scheme Start Date: 1st March 2023 End Date: 7th January 2026 Partners: University of Southampton, University of the West of England, South East Coast Ambulance Service NHS Foundation Trust, University of Ulster, Northern Ireland Ambulance Service Health and Social Care Trust, Marie Curie. Why did we do this work? Demand for end-of-life care (for people in the last year of life) is rising, driven by ageing population and increasing rates of people living with multiple conditions. This is causing increases in 999 calls to ambulance services with rates highest in areas of deprivation. In line with this rise in 999 calls for those at end of life, rates of ambulances transporting people to hospital are also increasing, which can lead to hospital deaths, a place where most people say they do not wish to die. Despite this little is known about paramedic practice in this context and service provision varies widely. What did we do? The study has for the first time investigated how ambulance paramedics support people in the last year of life following a 999 call, what challenges they face, and how services can best enable effective, compassionate care. More than 1,100 paramedics responded to a survey and over 100 patients, carers and healthcare professionals were interviewed. What did we find out? Ambulance paramedics provide supportive and compassionate care to individuals at end of life, but practice hampered by limited access to essential resources (specialist advice, patient records, advance care planning documents and medicines). Fear and uncertainty regarding end-of-life care undermine paramedic confidence. Limited education and training in palliative and end of life care contribute to skill and knowledge gaps. Gaps in access to other healthcare professionals mitigate against shared professional decision-making. Challenges with medicines access and administration impede symptom control by paramedics. Service shortages in primary, community and specialist palliative care services drive paramedic call outs and challenges in interdisciplinary collaboration limit quality of care. We have: Contributed evidence to Government’s consultation on proposals to extend medicines responsibilities for paramedics. Submitted written evidence to Palliative Care Commission focused on increasing paramedic confidence and coordination of paramedic delivered care at end of life. Secured follow on funding to deploy the survey developed and used in the study to understand the situation for ambulance paramedics in Northern Ireland. Marie Curie led press release November 2025 (to coincide with the publication of the ParAid policy brief) Urgent reform needed to support ambulance delivered end of life care . This led to national and regional radio interviews by the ParAid study CI and Marie Curie’s Director of Policy and Research. University of Southampton and Marie Curie press release February 2025 (following the publication of the findings of the ParAid national survey in England). This led to a wide range of news outlet outputs including BBC news online . Publications: Campling, N., Turnbull, J., Richardson, A. et al. Paramedics providing end-of-life care: an online survey of practice and experiences. BMC Palliat Care 23 , 297 (2024). https://doi.org/10.1186/s12904-024-01629-7

0b30aba5-25eb-4a0f-ba09-0cc56d28cb07 PROCED-DST: PROactive, Collaborative and Efficient complex Discharge – Decision Support Tool Chief Investigator: Dr Chris Duckworth, Senior Research Engineer, University of Southampton Email: C.J.Duckworth@soton.ac.uk Team: Professor Michael Boniface, Director of the IT Innovation Centre, University of Southampton, (HEI) Dr Carlos Lamas-Fernandez, Associate Professor, Southampton Business School Dr Dan Burns, Senior Research Engineer, University of Southampton Dr Mark Wright, Patient Flow Lead, University Hospital Southampton NHS Foundation Trust (NHS) Rachel Leyland, Complex Discharge Team Manager, Hospital Southampton NHS Foundation Trust (NHS) Ian Dickerson (PPIE) Partners: Hampshire and Isle of Wight NHS Foundation Trust, Hampshire Hospitals NHS Foundation Trust, Isle of Wight NHS Trust, Portsmouth Hospitals University NHS Trust, University Hospital Southampton NHS Foundation Trust, University of Southampton, Health Innovation Wessex. Start: 1/10/24 End: 31/3/26 Summary As of January 2023, 14,436 patients a day (14% of total capacity) remained in hospital despite being well enough to leave. This is due to delays in arrangements for onward care. Discharge delay occupies beds putting pressure on a wide-range of NHS services. There are currently 7.6 million patients waiting for treatment and an average waiting time of 15 weeks. Leaving hospital at the right time is also better for patients for many reasons. It reduces physical and mental deconditioning and chance of hospital infections. Part of the problem is organising further care required after a hospital stay. For patients in hospitals for seven days or more, 65% are delayed because they are waiting for after-care including care at home, short-term reablement and permanent care or a nursing home. Discharge planning involves lots of people and organisations from patients through to clinical teams in hospitals, community care, and local authorities. Organising care takes time considering the availability of social care services and mediation with patients and their families. It is therefore important that patients are assessed, and needs identified as early as possible within a hospital stay to give time for planning and conversations. An initial discharge assessment is supposed to be made with the first 24 hours of hospital admission. In practice this planning is provided for less than 50% of patients. Staff workload and inability to identify care requirements can delay assessments. Aims: In a previous project called PROCED, we developed a machine learning model to predict onward care needs when someone is admitted to hospital. Machine learning is a computer programme that can learn from information about patients and the services they use to make predictions. We have compared the model against predictions made by clinicians, and the results have shown it works well. In PROCED-DST we aim to investigate how a machine learning prediction can support better discharge planning. By planning care earlier during hospital stays gives more time for patients and families to discuss care needs with care workers. Ultimately we aim to improve the chance that patients can leave hospital on time. Approach: We will consider how a computer algorithm can help clinicians organise onward care by predicting admitted patient’s potential onward care needs. We will organise collaborative sessions with clinicians, patients, and computer programmers to understand how it could be used in the hospital and consider how it may benefit or impact patients. Patient and Public Involvement: Patients and Public will be directly involved in designing, testing and evaluating a decision support tool and help decide how it should be used by care providers to help plan onward care. PPI will influence data usage, patient journey, algorithms and how this should be communicated. The public will participate in a steering committee who will organise a series of workshops to engage patients and public in the research. Dissemination : Communication materials will engage the public and decision makers. We will work with PPIE support networks to develop accessible communication and ensure distribution to diverse communities. Evidence of effectiveness, safety and acceptance will be published. A decision support tool with computer-based decision support will be demonstrated. The outcomes will be championed with institutional, regional, and national implementation teams.

13151434-a7e4-409a-b026-23a834ceed8f IDA: Implementing a Digital physical Activity intervention for older adults Principal Investigator : Dr Kat Bradbury Project team : Dr Max Western , Dr Stephen Lim , Linda Du Preez , Fay Sibley , Dr Judith Joseph , Professor Lucy Yardley , Dr Chloe Grimmett , Dr Neil Langridge , Christian Brookes , Helen Fisher, Cynthia Russel, Asgar Electricwala, Tom Stokes, Professor Maria Stokes , Dr Paul Clarkson , Cherish Boxall, Dr Katherine Morton , Sara Bolton , Dr David Attwood. Partners: Hampshire and Isle of Wight Healthcare NHS Foundation Trust (Southern Health NHS Foundation Trust), Dorset County Hospital NHS Foundation Trust , Oxford Health NHS Foundation Trust, Health Innovation Wessex (Wessex AHSN), University of Southampton, NHS England, Energise Me, Active Partnerships, Live Longer Better. Publication: Implementing a Digital Physical Activity Intervention for Older Adults: Qualitative Study Summary This Active Lives website has been shown to help older people to increase physical activity. This study aimed to roll out Active lives to make it available to older people living in the community. The steps involved in the project included: Identify, approach and influence organisations interested in helping older people to be active in order to find places that could help us roll out Active Lives. Monitor how many people used active lives and how many were actively engaged enough to have what we think was a sufficient ‘dose’ of the intervention to be likely to change their behaviour. Interview people implementing Active Lives and study what happens in meetings to formulate a list of barriers and facilitators to the roll out of active lives. Results We worked with a wide range of organisations including AHSNs/HINs, charities which serve older people, physical activity organisations, NHS trusts and NHS England. The website reached 5002 people. 1306 people were engaged enough to view the core content necessary to lead to behaviour change. NHS England were instrumental in us achieving traction in several NHS trusts. Six NHS trusts and one charity agreed to help us roll out active lives. One physical activity partnership was helpful in facilitating relationships with their local NHS trust. Their support helped influence local trusts, build clinician confidence in Active Lives and help put in place strategies to maximise uptake of older people to Active Lives. Other physical activity partnerships and the physical activity sector more broadly chose not to support the implementation of Active Lives. Barriers here were especially focused on the belief that older people are not digitally engaged, that older people will only benefit from in person groups, and some viewed this as a threat to the groups that they were locally facilitating or supporting themselves. We appeared in competition with these organisations and it prevented uptake of several NHS trusts that appeared interested at our initial meetings with us (i.e. the physical activity partnerships became a barrier to NHS uptake as they had influence in these NHS trusts). Facilitators to uptake included confidence in the team, believing in an evidence-based approach, the team being able to allay concerns around digital accessibility, providing organisations with figures on how many people used the website and providing support with how to maximise uptake to active lives. Endorsement by NHSE was also very useful in persuading some NHS trusts to take on Active Lives. Things that slowed roll out down: Complexity in the NHS trusts’ chain of command slowed the sign up to Active Lives, this was problematic in a 12-month project. NHS trusts also required complex and nuanced data security and other digital health forms to be completed and trusts were overly cautious with regards to the perceived digital security risks of the intervention. This caused long delays and used valuable resources. What have we done? We implemented Active Lives in practice across 6 NHS trusts, having direct impact on older people. 5002 used it, of which 1306 were actively engaged to a level which we believe is a sufficient ‘dose’. We’ve written a paper on the barriers/facilitators https://aging.jmir.org/2025/1/e64953 What have we learned? Despite the short nature of this project, it achieved good impact and was able to support a large amount of people in a short amount of time Support from all partners is needed to overcome barriers to implementation. Further roll out would require continued engagement work to allay concerns among the NHS and partner organisations

d213d93c-85f6-44bc-bd30-219d08d1075e Material Citizenship Framework Project Principal Investigator : Professor Jackie Bridges (Professor of Older People's Care, School of Health Sciences, University of Southampton) Co-investigator : Dr Kellyn Lee (Visiting Fellow, School of Health Sciences, University of Southampton) Researchers: Dr Jane Frankland, Leah Fullegar Collaborator: Zoe McCallum (Chief Operating Officer, Brendoncare) Started : 1 February 2020 Completed: 30 November 2022 Project partners: Brendoncare Foundation. Co-funded by University of Southampton ESRC Impact Acceleration Account, Alzheimer’s Society, The Brendoncare Foundation Concept Material Citizenship, a new approach to dementia care, uses objects used to carry out tasks (such as a mobile phone or curling tongs) as a mechanism for improving the care experience for care home staff and people living with dementia in care homes. It does so by: Encouraging care home staff to include personal possessions in care plans Support use of personal possessions to maintain routines and rituals Enable people living with dementia to carry out everyday tasks, supporting them to the live the life they want to live Impacts Material Citizenship training was delivered to four care homes, part of two care organisations in the UK. Adopting a Material Citizenship approach has had a positive effect on many of the people who live, work and visit these care homes. According to one care home manager, taking a Material Citizenship approach has transformed how they provide care. They have seen an improvement in the wellbeing of residents and increased confidence in staff who attended the training. Care home staff are now supporting people living with dementia to engage in meaningful activities such as delivering newspapers, baking bread and polishing their own rooms – with the polish they like. It has also had a more fundamental impact on the care practices of a care home. In one care home the manager gave an example of how it has changed the culture in the care home. Prior to introducing Material Citizenship catering staff worked certain times of the day and food was restricted to set meal times. This has changed and catering staff are now available to support residents in meal choices and meal times that suit them. It was also reported that prior to Material Citizenship, time restrictions of when people should leave the care home and return to the care home were in place. Residents no longer need to be back at certain times, they have more freedom to come and go as they wish, something noted by an external healthcare professional as being wonderful. Material Citizenship has enabled care home staff to grow in confidence. Prior to attending training care home staff were observed to be frequently deferential when interacting with visiting healthcare professionals. Now care home staff are more willing to engage and assert themselves to get the best possible outcome for residents. By applying a Material Citizenship approach it has been reported staff are less likely to rush to the assumption that medical intervention might be the best way forward to to reduce behaviours they find challenging. Instead, staff are using objects as a way of exploring why a person may be communicating in a negative way and have more confidence when working with people living with dementia. Publication: Material Citizenship: An ethnographic study exploring object–person relations in the context of people with dementia in care homes

71793130-6407-4a7a-8ebf-2af1daf96dd5 Understanding the psychosocial needs and trajectories of older adults (>64 years) with alcohol use disorder (AUD) from hospital back into community Lead applicant : Professor Julia Sinclair Co-applicants : Dr Rebecca Band, Professor Jackie Bridges Team Dr Steph Hughes – Research Fellow Zara Linssen – Medical Student Sophie Crouzet – Medical Student Stephen Lim – Implementation Champion Melinda King – PPI advisor Start: 01/01/2023 End: 01/07/2024 Partner organisations: University Hospital Southampton NHS Foundation Trust University of Southampton Background Over 200 physical and mental health conditions are caused by alcohol. In England, more people are being admitted to hospital with, and dying from, alcohol-related disease than ever before. In 2018/19, 44.7% of all alcohol related admissions were for people over the age of 65 compared with 14% in 2010/11. In 2021,1563 patients were assessed by the Alcohol Care Team (ACT) at University Hospital Southampton, 43% of whom were over the age of 60. We know that older adults can often feel more shame and stigma related to their alcohol use compared with younger people. This can create barriers to accessing help with existing community addiction services. Beyond this, very little is known about the reasons why older adults drink alcohol and how this may interact with other social factors like loneliness and social isolation. Further research is needed to understand the ways in which to best support older adults to seek help, and what interventions may best promote positive outcomes. Study Design This study will recruit older people with alcohol use disorder (AUD) admitted to hospital in Wessex. A longitudinal observational design will be used, meaning that people in the study will be asked by the research team to complete questionnaires over time following admission into hospital. This will help to understand the needs of the population. There will be four main research aims: What are the personal characteristics of older adults with AUD? How do participants make sense of themselves in relation to their alcohol use? What happens to participants in the six months following a hospital admission? What factors what might prevent or encourage people from seeking help for their alcohol use? Study Methods The study will identify potential participants through the ACT in Southampton in the first instance. Around 40% of people seen over the age of 65 years. Clinicians working in ACTs have the skills and experience to sensitively identify and assess patients with comorbid alcohol use disorders Discussion about the study and consent processes will be undertaken by the UHS clinical trials officer. Participants who are willing to be part of the study will complete a set of questionnaires in hospital. Well-established measures of alcohol use, quality of life, loneliness, collective efficacy and health service use will be collected. Participants will be asked to complete similar questionnaires again at 3 and 6 months. This will probably take place over the phone. Health service use data will be collected for the 6 months after discharge to explore resource use. Plain English summary of findings Recruitment to the study was difficult. Many patients who were identified as drinking at increasing or possibly dependent levels did not have mental capacity to take part. Of those who were eligible, a large percentage declined to participate. This resulted in a small sample size of 30, 16 of which completed their follow-up questionnaire, and 7 interviews. 20% of the sample died during the study window. Results indicated: Over 50% participants showed some level of cognitive impairment Participants had an average of 4 people in their social network; usually family members Interviews revealed links between social isolation, loneliness and drinking alcohol Those who were housebound reported drinking alcohol all day long Participants stated alcohol is not, and never has been a problem for them 50% participants met the threshold for depression Participants often provided conflicting information for the follow-up questions and in the interviews Participants had poor diets; of 32 nutrients measured 22 were not consumed in-line with the government recommendations 93% participants were taking 5 medications or more What's next? As a small preliminary study the new knowledge has been used to inform future research. Impact on patient care and population health will come from the future research. Recruitment was harder than expected. This learning point has informed recruitment and retention procedures in future research applications. Other findings, for example, the link described qualitatively between social isolation and increased alcohol consumption, has shaped ideas for intervention development. We are preparing an application to undertake the planning and developmental work for an intervention aimed at reducing alcohol consumption in a general population of adults aged 65 and over. We plan to test the feasibility of this intervention in a feasibility study.

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)

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

f6f0f7ec-ab98-4c5c-9b52-2674a93b8c90 ADOPTED: A Study to Evaluate the Introduction of new Staffing Models in Intensive Care: a Realist evaluation (SEISMIC-R) Prinicipal Investigator: Professor Natalie Pattison, University Of Hertfordshire Team: Professor Peter Griffiths, Dr Chiara Dall'Ora, Dr Christina Saville, Dr Lisa Whiting, Dr Melanie Handley, Dr Susie Pearce, Dr Marion Penn, Dr Paul Mouncey, Professor Thomas Monks, Mrs Clare Leon-Villapalos, Professor Suzanne Bench, Professor Ruth Endacott, Mr Jeremy Dearling, Mrs Jennifer Gordon. University of Southampton, University of Hertforshire, University of Plymouth, Intensive Care National Audit & Research Centre, University of Exeter, Imperial College Healthcare NHS Trust, Guys & St Thomas' NHS Foundation Trust/London South Bank University, NIHR Clinical Research Network. Start Date: 01 May 2023 End Date: 31 August 2024 Background Staffing in intensive care units (ICU) has been in the spotlight since the pandemic. Having enough nurses to deliver safe, quality care in ICU is important. There is national guidance, re-issued in April 2021, on how many nurses should care for ICU patients. However, what the skill mix should be (how many should be qualified nurses or have an ICU qualification) is unclear. Very little research has been done to look at which nursing staff combinations and mix of skills works best in ICU to support patients (described as ‘staffing models’). Across ICUs in UK, various ratios of qualified and unqualified nursing staff are being tried (staff ratios refer to the number of nurses caring for a set number of patients). Hospitals vary; some use a high proportion of non-registered nurses and others a low proportion of ICU qualified nurses. Research shows that there is a link between the quality of nurse staffing and poor patient outcomes, including deaths. Aim : Our research plans to look at different staffing models across the UK. We aim to examine new staffing models in ICU across six very different Trusts. We will use a research technique called Realist Evaluation that examines what works best in different situations and helps us to understand why some things work for some people and not others. The design of this approach will help us to better understand the use of different staff ratios across different ICU settings. We will examine what combinations of staff numbers and skills result in better patient care and improved survival rates. Our aim is to produce a template that every ICU unit can use. To do this, we will compare staffing levels with how well patients recover, and seek to understand the decisions behind staffing combinations. Publications Nurse staffing configurations and sickness absence in English intensive care units: A longitudinal observational study - ScienceDirect ICU staffing and patient outcomes in English hospital Trusts: A longitudinal observational study examining ICU length of stay, re-admission and infection rates - ScienceDirect

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