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8f830c4b-12f3-482a-9f50-095a9cd14973 ADOPTED: Gambling in the UK: An analysis of data from individuals seeking treatment at the NHS Southern Gambling Service Principal Investigator: Professor Sam Chamberlain, Professor of Psychiatry at University of Soutampton & Honorary Consultant Psychiatrist at Southern Health NHS Foundation Trust. Co-investigators: Professor David Baldwin, University of Southampton, Professor Jon Grant , University of Chicago, Dr Konstantinos Ioannidis, Southern Health NHS Foundation Trust, Dr Mat King, Southern Health NHS Foundation Trust. Partners : University of Southampton & Southern Health NHS Foundation Trust Summary Gambling disorder is a growing problem amongst adult gamblers. Although previous research has identified some of the harms associated with gambling, few studies have documented how these harms in a large, UK clinical sample. Moreover, It is critical to investigate the socioeconomic determinants of gambling disorder via geospatial analyses, bringing together clinical and socio-economic parameters, to identify areas of need and inform the strategic development of the regional service as well as influence policy making more widely. Furthermore, little is known regarding the evolution of factors that predict treatment success dropout or relapse and how individual vulnerabilities interact with environmental risk. This research aims to fill this gap, by analysing a large existing dataset of treatment seeking gamblers. The service has a purpose to provide clinical excellence, while adopting innovative methods (digital pre-assessment, digital monitoring, virtual individual and group therapies etc.) in the clinical setting and to spearhead cutting-edge research which will inform and enhance clinical practice locally, nationally, and globally. The long-term goal of the service is to establish a world-renowned centre that minimises gambling harms through comprehensive evidence-based treatments, research, outreach, and prevention (including early interventions). The clinical focus of the Southern Gambling Service (SGS) is on minimising gambling harms, which involves treating disordered gambling using evidence-based approaches, as well as providing support aimed to promote or replenish recovery capital in individuals (e.g. detecting comorbidities and signposting individuals to other sources of support, enhance social connectedness, promote liaison with sources of financial, social and wellbeing support, setting out the scaffolding of follow up arrangements).

a3233a2e-82c9-4634-a984-44c5ddb93cad ADOPTED PROJECT: MELD Developing a Multidisciplinary Ecosystem to study Lifecourse Determinants of Complex Mid-life Multimorbidity using Artificial Intelligence (MELD) Chief Investigator: Dr Simon Fraser – University of Southampton Project Team Members: Dr Nisreen Alwan – Associate Professor in Public Health, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Professor Michael Boniface – Director of the University of Southampton IT Innovation Centre and Web Science Institute, Professor Ben MacArthur – Mathematical Sciences University of Southampton, Professor Rebecca Hoyle – Mathematical Sciences University of Southampton, Dr Sarah Crozier – Associate Professor of Statistical Epidemiology, MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Mr William Ware – Patient and Public Involvement Contributor, Mr James McMahon – Patient and Public Involvement Contributor, Dr Emilia Holland – Public Health Specialty Registrar, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Dr Zlatko Zlatev – Senior Enterprise Fellow, Electronics & Computer Science, University of Southampton Background: As with many countries we are facing challenges related to the growing number of people living with multiple long-term health conditions like diabetes, heart disease or dementia. All the way through peoples’ lives many things influence the chances of developing such conditions. This includes some things that are hard to research - broader issues throughout life such as the environment people grew up in, their education, work, and so on. Sadly, people from more socially and economically disadvantaged backgrounds are more likely to develop multiple conditions at an earlier age. There is also evidence that the order of developing conditions varies considerably and influences what then happens to people. This makes understanding these broader issues and how they affect that order vital to inform when and how we should intervene to prevent conditions developing. To achieve this, we need to study large numbers of people over their whole lifetime, but such datasets do not exist. Very large health datasets collected from NHS GPs are helpful but haven’t been running long enough to track from birth to later life. They include lots of information on long term conditions but not much about broader issues. In our Development Award (called ‘MELD’) we had access to one such dataset of about 700,000 people, which we used to identify health conditions. We also accessed data from the ‘1970 British Cohort Study’ – a long-running research study called a ‘birth cohort’ Publication: Early-onset burdensome multimorbidity: an exploratory analysis of sentinel conditions, condition accrual sequence and duration of three long-term conditions using the 1970 British Cohort Study https://bmjopen.bmj.com/content/12/10/e059587.full

c21aafd4-fa4e-48e5-85b7-6fda5c6ab3a5 POST DOCTORAL PROJECT: The career aspirations of nurses working in the research delivery workforce: a cross-sectional survey Chief Investigator: Dr Miriam Avery – University of Southampton and University Hospital Southampton NHS Foundation Trust Organisations Involved: University of Southampton, University Hospital Southampton NHS Foundation Trust. Background: We know that nurse-led research in health and social care is crucial to enable nurses to deliver high quality care based on the best available evidence. Nurse-led research is being generated within higher education institutions and a small number of NHS roles, but nurses remain an under-represented group in health services research. There is a clear capacity problem for nurse-led research. Within the NHS, the largest group of nurses working in research are in research delivery roles. This section of the nursing workforce has experience, skills, and competencies in delivering research within a health and social care environment from start to finish. All these skills are of prime importance when designing and leading a research study. However, as there is little published data on the career aspirations of this group of nurses, the extent to which they have the desire to progress an independent researcher career and build capacity for nurse- led research is unknown. The aim of the study is to undertake an online survey of nurses working in research delivery roles in local acute NHS Trusts to determine the career aspirations of this group of nurses. The study is at a very early stage, with the research proposal and protocol in the process of being developed. We expect the set-up and recruitment phase to be completed by the autumn of 2022. The planned online survey includes questions around the current activities of nurses in research delivery roles, as well as training, skills, competencies, and career aspirations. The findings from the survey will provide much needed data about the aspirations of this group of nurses, which will determine the next phase of this research project. If there is aspiration for independent research amongst a section of this workforce, then there is an urgent need to facilitate progression along this career path. Summary of Findings We found that…. • Respondents: 298 Nurses, midwives and AHP’s in the research delivery workforce completed the survey (43% response rate) about ‘research leader’ career aspirations. •Nearly a quarter ‘aspired’ to be a research leader; around a half ‘might aspire’. •Of those aspiring, most (70%) found it difficult or very difficult. Only around a third were confident of achieving ‘research leader’ within 5 years. • Publications: only 21% had been a named author on a peer-reviewed publication • Funding: Most (81%) had no idea or were uncertain as to where to apply for funding •The factors that most respondents identified would help them achieve this goal were: clearer career paths into research leader roles , more guidance and support in making career choices and more mentorship opportunities . • Conclusion: there appears to be a large number expressing some potential aspiration for leading research within the nurse/midwife/AHP research delivery workforce – is this untapped potential? What did we do with this knowledge? - The knowledge from this study has relevance to academics and the clinical research delivery workforce. - Local communication: Presentation of the findings at University Hospital Southampton Research & Development Quarterly Forum meeting. The audience was mainly Research Delivery staff and management. - International conference: Abstract and poster at the RCN International Research Conference in Manchester (6th-8th September 2023). - Direct NIHR presentation: The findings of the survey were presented to Professor Ruth Endacott (NIHR Director of Nursing & Midwifery). What is next? We are planning 2 publications and an update to NIHR.

5241b3d8-a7e9-409f-8d8a-e86421d8cdd5 Evaluating impact of personalised care at service at service and system levels: Learning from the Wessex Academy for Skills in Personalised Care (WASP) programme. Chief Investigators: Professor Mari Carmen Portillo, Professor of Long-Term Conditions. School of Health Sciences. University of Southampton, Dr Louise Johnson, Consultant Therapist and WASP Project Lead, University Hospitals Dorset Team: Dr Beth Clark, WASP Personalised Care Facilitator, University of Southampton Matthew Wood, WASP Digital Lead and current ARC Wessex Statistical Intern Dr Hayden Kirk, Consultant Physiotherapist & Clinical Director Adults Southampton, Solent NHS Trust Janine Ord, Head of Population Health, Dorset Integrated Care Board Fran White, Director of Policy, Innovation and Partnerships, Hampshire and Isle of Wight Integrated Care Board Aisling Flynn, Lecturer in Occupational Therapy and Post-Doctoral Researcher, Bournemouth University Sally Dace, Patient and Public Involvement Representative Luisa Holt, Research Fellow, University of Southampton Partners: Dorset Integrated Care Board, Hampshire and Isle of Wight Integrated Care Board, Dorset County Hospital NHS Foundation Trust, University Hospitals Dorset NHS Foundation Trust, Hampshire and Isle of Wight NHS Foundation Trust, Bournemouth University, University of Southampton. Start: 1 October 2024 End: 31 March 2026 Aim(s) To evaluate if and how the Wessex Academy for Skills in Personalised Care (WASP) programme has led to improvements within healthcare services, and the impacts for patients, services and the wider health system. Background Personalised care focuses on tailoring health services to individuals’ needs and preferences. People who receive personalised care have greater satisfaction, and are more likely to feel in control of their own health and wellbeing. Services that work in a personalised way are likely to use their resource more efficiently - by offering people the right support, in the right way, at the right time. Despite the benefits, widespread adoption of personalised care has been slow. There are many reasons for this – including having healthcare staff who are trained and believe in its importance, and having systems that support its delivery. Since 2018, the Wessex Academy for Skills in Personalised Care (WASP) has been helping NHS services to improve personalised care delivery. This support involves three parts: EVALUATION –understanding current care by collecting the views of service users, frontline clinicians, managers and people who plan services (commissioners) LEARN – training healthcare teams, so they have the knowledge, skills and confidence to change how they work IMPLEMENT – supporting services to identify and deliver improvement projects, with measurable benefits for patients In this research, we will evaluate impact of the programme. This is important to: · know how to improve WASP in the future; · learn how to accelerate the adoption of personalised care within the NHS; · demonstrate impact, so we can spread the benefits more widely. Design We will create a series of case studies from services that have already completed WASP, highlighting learning from the programme, if/how this has been put into practice, and the benefits to service users. We will use interviews and surveys to collect information from healthcare staff, who are working in services that completeWASP in 2024/25. This will allow us to understand peoples experience of the programme, and the impacts this leads to. Interviews will take place at several timepoints, understanding learning development over time. Results will be considered together. Patient, public and community involvement Patient and public feedback has been incorporated into this proposal. Throughout the research, we will work with patient contributors, including a co-applicant, to shape and develop the research programme, ensure we are capturing the most important impacts, and to develop accessible ways to share our findings. Dissemination We will use the findings to create recommendations for how the WASP programme can be improved and spread in the future, reaching more people with long term conditions. We will share results at conferences and in academic journals; and presenting in a range of accessible formats, using the WASP website, social media and in the community.

945aa457-32c2-485e-a4e6-687eee387f97 ADOPTED PROJECT: Optimising Outpatients: Effective service transformation through face-to-face, remote and digital care delivery Principal Investigator: Professor Chris Kipps, Consultant Neurologist at University Hospital Southampton NHS Foundation Trust Research team: Patricia Fuller, Sarah Fearn, Sally Dace, Amanda Wollam, Angeliki Zarkali, Adam Cowan, Sam Mountney, Georgina Carr, Sofia Eriksson Starts: 1/2/2022 Ends: 31/07/24 Background Remote consultations are now a routine part of neurology outpatient care. Their rapid expansion during the COVID-19 pandemic demonstrated clear benefits, including greater convenience, reduced travel, and improved flexibility for patients and carers. However, it also exposed important challenges relating to clinical assessment, communication, privacy, digital access, and service organisation. While national policy strongly supports digital innovation and outpatient transformation, there has been limited evidence on how best to combine face-to-face, telephone, video, and digital communication in everyday neurology practice. REMOTE-Neuro was developed to address this gap by combining national-scale data with co-production to generate a practical, evidence-based framework for optimising hybrid care. Why this research matters Remote care has become embedded in the NHS faster than the evidence and systems needed to support it. At the same time, national strategies promote hybrid care, patient choice, and digital inclusion, but offer limited practical guidance on how to translate these ambitions into real-world outpatient services. REMOTE-Neuro was designed to bridge this translational gap by developing clear, stakeholder-informed recommendations grounded in how care is actually delivered by clinical teams and experienced by patients and carers. What we did We used a two-phase mixed-methods approach. National analysis We analysed free-text responses from: 2,463 patients and carers (Neurological Alliance survey) 593 neurologists (Association of British Neurologists surveys) This provided one of the largest multi-stakeholder datasets on remote care within a single specialty. Co-production We then worked with 64 patients, carers and healthcare professionals through workshops, interviews and focus groups to: validate findings refine interpretation co-produce practical recommendations The final outputs were aligned with the NHS Long Term Plan and the Outpatient Recovery and Transformation Programme. What did we learn? Participants valued flexible choice in consultation modality, recognising the accessibility and convenience of remote care, but expressed concerns about clinical quality, privacy and equity. Both patients and clinicians viewed remote care as a distinct skill set requiring tailored training and stronger digital infrastructure. A particularly important finding was that some patients appeared to perceive remote appointments as less legitimate or lower value than face-to-face care. This has implications for engagement and equity and exploring and addressing this legitimacy gap is likely to be just as vital as any technical upgrade. What we recommend We co-produced the REMOTE-Neuro Framework: REcommendations for optimising Modality, Operational efficiency, Training and Equity in NEUROlogy The framework focuses on practical, implementable changes, including: supporting real patient choice of appointment type where clinically appropriate using robust triage systems to match patients and problems to the right modality recognising remote care as a distinct clinical skill, with training and support for staff developing clear, co-produced information to help patients prepare for remote appointments ensuring access to private, confidential consultation spaces maintaining capacity for timely face-to-face follow-up when needed improving booking systems, and digital infrastructure protecting time for service development and innovation monitoring services for equity, safety, and patient experience Rather than acting as a rigid checklist, the framework provides a structured, adaptable approach that services can use to implement and evaluate hybrid neurology care in their local context. What difference could this make? REMOTE-Neuro provides a practical route from broad policy ambition to real-world implementation. Rather than serving as a rigid checklist, REMOTE-Neuro is designed to be adapted through local co-design and aligned with available infrastructure. It prioritises what matters most to staff and patients to enable continuous and meaningful quality improvement over time. It helps services address key questions such as: Which patients are best suited to remote or face-to-face care? How can safety and quality be maintained within hybrid models? What support do patients and staff need to make remote care work well? How can services reduce inefficiencies while improving experience? Although developed in neurology, these challenges are shared across many specialties. The framework therefore has wider translational relevance for outpatient services across the NHS seeking to optimise hybrid care. What was the impact? REMOTE-Neuro has already made a contribution to academic, clinical, and policy discussions. The study has been published in BMJ Neurology Open as REMOTE-Neuro: Co-produced Recommendations to Optimise Remote Neurology Care Professor Chris Kipps was invited to give a platform presentation on the work at the Association of British Neurologists national conference in Edinburgh The Neurological Alliance presented the findings to the NHS England Transformation Team The outputs have informed local outpatient transformation discussions at University Hospital Southampton The recommendations are contributing to ongoing discussions with the ABN Quality Committee regarding the development of a clinical guideline for remote appointments in neurology This demonstrates early impact at both local and national level, and positions the work as a practical contribution to current debates on outpatient redesign. What’s next? Next steps include: supporting implementation and evaluation of the framework in practice developing more detailed neurology subspecialty guidance contributing to the development of a clinical guideline for remote appointments in neurology with the ABN Quality Committee further research into issues such as patient perceptions of value and equity in hybrid care More broadly, REMOTE-Neuro provides a strong foundation for ongoing work on inclusive, person-centred outpatient design across neurology and other specialties navigating the optimisation of hybrid care.

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

98ea6e39-72b8-439c-baa8-0843050c271b ADOPTED: SPLENDID Social Prescribing for people to Live ENjoyably with Dementia/memory problems In Daily life Research lead: Professor George Christopher Fox, University of East Anglia ARC Wessex team: Dr Euan Sadler, University of Southampton, Dr Katherine Bradbury, University of Southampton. Partner organisations: NHS Norfolk and Waveney CCG, University of Hull, University of Nottingham, University of Exeter, King's College London, University of Newcastle upon Tyne, Meaningful Measures Ltd. Start: 01/05/2022 End: 30/04/2027 What is the problem? Nearly one million people in the UK will be living with the affects of dementia by 2030 including poor well-being and quality of life. Social prescribing is a prescription of activities for a person to use to link with others and undertake something they might enjoy, this could be a walking or singing group, flower arranging class, visit to a museum or putting them in touch with other people to help them feel better. People meet with staff called Link- Workers, who have a conversation with them to help them think about what they enjoy and might help. The Link Worker might then introduce them to a group or activity or support them to find information to make links. Family members can be involved too. Research shows social prescribing has better effects than just taking medicine and is happening more often. This study (called SPLENDID) aims to understand how we ensure social prescribing is useful and helpful to people with dementia. What we will do SPLENDID researchers will talk with people with dementia, family carers and staff working in social prescribing to understand what people want, what works well and what could be improved. We will use this to design, with people with dementia, what looks like the best way for social prescribing with people with dementia. We will create some tools (online and face-to-face) to help workers and people with dementia talk and think together about what might help them. We will test it with a small group of people to see if it helps and look at what training Link- Workers need to offer the best support for people with dementia and their families. We then decide if this should be taken forward and tested in a larger study to see if it improves peoples’ well-being and is value for money. Working with patients and carers Our team met 8 people with dementia and 8 family carers to design this study. We have 2 co-researchers (Mr Rook and Mrs Bingham) who are living with dementia. 150 people with dementia were surveyed to see what social prescribing is currently being offered and found people were doing a range of outdoor and indoor activities, some with family which they enjoyed and found helpful. People with dementia and carers will be on our Committees, and several dementia charities support this work. Dissemination Our website will offer free resources put together with people with dementia and carers. Our findings will be shared locally and nationally using links we have with universities, clinical experts, press, social media, workshops with people who commission and provide. NIHR ARC East of England study site Publications Social prescribing for people living with dementia (PLWD) and their carers: what works, for whom, under what circumstances and why – protocol for a complex intervention systematic review | BMJ Open

6bbcedc2-84c3-4fab-84e5-93672150e077 ADOPTED: Social Prescribers In Deprescribing Role (SPiDeR) Team: Dr Kinda Ibrahim, Pharmacist and Lecturer, Faculty of Medicine, Deputy Lead Ageing and Dementia, ARC Wessex Dr Sara McKelvie, NIHR Clinical Lecturer in General Practice Dr Eloise Radcliff, Research Fellow, Faculty of Medicine Emma Ward, 3rd Year Medical Student Lizzie Wimbourne, PhD candidate and Policy Intern (supported by Gareth Giles) Dr Laura Bryant, GP and School of Primary Care Apprentice Pam Douglas and Neil Wilson, Public Contributors and Co-applicants Senior Support Prof Hazel Everitt, Dr Stephanie Tierney, Prof Peter Griffiths and Prof Joanne Reeve Starts: April 2023 Ends: September 30, 2024 In the UK, a third of all people aged 65 years and above regularly take five or more medications, known as polypharmacy. Polypharmacy can increase the risks of side effects and hospital admissions. One of national priorities for NHS England set by the Chief Pharmacist, is to reduce prescribing unnecessary medication (overprescribing) by 10% for patients being treated by their GPs. One important way to identify and stop harmful medication is called a Structured Medication Review (SMR) but only half of older patients attended their GP practice for this in 2018-19. Instead of medicines, some people might benefit from other activities such as changes in diet, ways to reduce stress, increasing exercise or participating in group activities. Social prescribers are starting to work within GP teams to direct people to some of these activities. The Chief Pharmacists report on overprescribing suggested that NHS England should expand the use of SMRs in GP practices to benefit patients most at risk of overprescribing. They also recommended the involvement of trained social prescribing link workers as part of GP teams to support patients during and after a SMR. We currently don’t know how social prescribers can be integrated in the SMR process or whether this will have an impact on overprescribing for older people. The aim of this study is to explore the role of social prescribers in the SMR process and identify any training needs or resources required to enable their active involvement in the process. We will hold focus groups with healthcare professionals (GPs, pharmacists and social prescribing link workers) and interview older people who have experience of taking several medicines and/or their caregivers to: 1- Understand whether there is a role for social prescribers in SMR in Primary Care teams 2- Identify training needs for social prescribers to be actively involved in Primary Care teams who are doing SMR reviews 3- Identify factors that might prevent or improve social prescribers’ involvement in SMR 4- Consider what older people and healthcare professionals felt about alternatives to medications and map relevant activities and guidance that could be used as a substitute to medications such as dietary advice, exercise groups or cognitive behaviour therapy 5- Develop a model to describe how social prescribers can be best involved in SMR Understanding the role of social prescribing link workers in the SMR process might increase the use of non-medical solutions for health-related problems and reduce overprescribing. This study could help develop the role of social prescribers and understanding how they could work in primary care to support SMR. We hope this research will help us design and test different models of how social prescribers can work within GP teams to support deprescribing. This project is linked to STOP-DEM and MODIFY SPiDeR project for ARC Wessex 18.9.23 .pptx Download PPTX • 6.89MB

d9f3030e-3acc-4dc2-87bc-c01e65471d56 FLEXI: Falls management exercise programme led by NIHR ARC East Midlands working with NIHR ARC Greater Manchester and NIHR ARC South West Peninsula The FLEXI Study (FaLls EXercise Implementation) Lay Summary Falling can cause injury, pain, loss of confidence and independence. This is undesirable for the individual and their families, and places significant demands on health and social care services. Falls are not inevitable. By improving an individual’s strength and balance, alongside skills to help getting up from a fall (should this happen), the likelihood of a fall occurring or having damaging consequences, such as a long lie on the floor, can be minimised. The Falls Management Exercise (FaME) programme is a group-based, face-to-face, six-month exercise programme specifically aimed at improving the strength and balance of people aged 65 and over. Research has shown that FaME results in fewer falls, improved confidence, and reduced fear-of-falling. Despite this, FaME is still not available everywhere across England. More needs to be understood about how best to increase its availability and ensure high quality delivery. To improve our understanding of this, we previously studied FaME’s set-up, delivery and quality in the East Midlands. We learnt a lot about how to get FaME running and showed that the programmes worked outside of a research setting. Using learning from the East Midlands, we developed a guide for implementing FaME called the implementation toolkit . This evidence-based toolkit contains all the information needed to set up and run a FaME programme, from making the initial business case to promoting it to participants. “FaME gives value. We know it's great value for money. We know it works in terms of it reduces falls, it increases physical activity, improves function, improves confidence. So many different benefits” What have we discovered? What works to foster (encourage) the adoption (initial decision to choose or take up something) and spread (roll out over a large area) of The Falls Management Exercise (FaME) programme ? Using implementation frameworks, we successfully identified key barriers and enablers of adoption, implementation and spread of the Falls Management Exercise (FaME) programme across the three localities. We found that the adoption, implementation and spread of FaME into community settings is complex and faces multiple health system challenges. In order for the FaME programme to be chosen as a community fall prevention intervention by commissioners, the programme must be able to demonstrate how successful it is in reducing falls for older adults (this is often determined by internal service evaluation). The programme was also required to fit the needs of those receiving the intervention, for example, FaME was primarily provided where there was a growing, aging population in need of fall prevention interventions. The spread of the FaME programme within organisations and into new regional areas was dependant on the input of commissioners passionate about fall prevention. Commissioners were required to support this roll out and provide funding, whilst also ensuring that there was a sufficient expert instructor workforce available to deliver FaME. The programmes were further required to be monitored regularly to evidence how successfully each programme was in reducing rate and risk of falls for older adults receiving the intervention. This was often the role of the postural stability instructor. Future funding is required to build in paid time for this to ensure that programme outcomes can support future funding cycles as often instructors are funded on an hourly basis. Does FaME work in the real world, how is it adapted (altered or changed), and does it reach the intended audience (older adults at risk of falling)? The collection of routine class data across three regions in England demonstrated that FaME was associated with benefits for participants at 12 and 24 weeks of the programme. Those benefits included improved balance and mobility and reduced falls. Programmes that provided higher ‘dose’ (i.e. ran over 24 weeks rather than 12 weeks) found that older adults experienced greater improvements in balance and mobility and were less likely to be concerned about falling again. What works to maintain the quality (the standard) and fidelity (how well something is reproduced) of the FaME programme over time? One of the key findings of the FLEXI study was that sites demonstrated a lack of clarity of essential components or key ingredients of the FaME intervention. This influenced both implementation and the providers' ability to assess adherence. The need for an understanding of central components was also clear in understanding delivery adherence and, therefore, the ability to evaluate programmes for their effectiveness. At the point of implementation, it became apparent that commissioners and managers are prioritising aspects of the intervention, with these decisions mediated by knowledge (or lack ) of the intervention, economic culture and organisational priorities. Adaptation of Evidence Based Interventions is key to improving their fit in a new context, however, essential components should not be adapted as intervention effectiveness cannot be guaranteed. We have proposed a new framework of implementation fidelity, that shows that mediators were key both in the implementation and delivery of complex interventions, as well as the mediating more of global mediators. Understanding of essential components is paramount at the point of implementation in order to ensure fidelity is implemented, maintained, and assessed. We suggest that complex interventions have a standard of evaluation (based on core components) and insights on fidelity/value negotiations within toolkits. We highlight that local fidelity evaluation is key to standardisation across programmes and delivery. What difference does this knowledge make? We have worked collaboratively with the Health Innovation Networks (HINs), local Integrated Care Systems and Combined Authorities to study ‘spread in action’. As a result, in one of our areas (Devon), where we have applied HINs spread methodology, we have seen a near trebling of available programmes from 13 to 41 (without intervention costs from the study). The study has highlighted the need for an increased frequency of local Quality Assurance to monitor delivery (instructors given the opportunity to observe each other deliver and provide constructive feedback). This has improved the quality of delivery. We have also hosted Greater Manchester-wide collaborative events, which resulted in quality improvement initiatives relating to FaME provision across GM and have established the National FaME Implementation Team (N-FIT) which is now primed and ready to work in new areas to support spread, using the methodologies we have tested. We are refining our implementation toolkit, which is ready to be tested in new areas and we want to refine and improve our quality assurance framework and costing tool using data collected from the study to support future FaME provision. What next? Our future planned work aims to address: Gaps in our understanding about what works to reach underserved communities in relation to FaME participation. We are currently working to explore the provision of FaME in ‘neighbourhood’ areas where there are good examples of reach into underserved groups (e.g. minority ethnic groups, male participants and socioeconomically deprived areas). We are conducting case-study research methodologies to further investigate this aim. The original FLEXI project highlighted that the monitoring and evaluation of programme outcomes are not captured well by local areas delivering programmes. We are, therefore, now developing a more structured evaluation framework for sites to use a legacy of the project. New data on the costs of implementing FaME have been determined and we would love to use these figures to update the national return on investment tool for FaME, developed by Public Health England and York University, to see if this improves the economic case for FaME roll-out. Lastly, we have also tested quality assurance tools for FaME and can see that improvements can be made to increase the tools’ internal and external validity. Moving forward, we would like to refine our preferred tool using academic methods to test this in new areas. FLEXI output links digital .pdf Download PDF • 616KB We would like to thank: Principle Investigator: Dr Elizabeth Orton Team members: Professor Denise Kendrick , Professor Stephen Timmons , Professor Carol Coupland , Professor Pip Logan , Professor Tahir Masud , Professor Vicki Goodwin , Professor Claire Hulme , Professor Chris Todd , Dr Helen Hawley-Hague , Dr Paul Wilson, Professor Dawn Skelton , Mrs Margaret Beetham Study researchers and study staff: Dr Fay Manning Dr Jodi Ventre Dr Aseel Mahmoud Dr Basharat Hussain Dr Michael Taylor Dr Grace Brough Dr Amar Shukla Dr Robert Vickers Ms Tina Patel Study public contributors: Mary Murphy Margaret Beetham PPIE Workshop participants from Greater Manchester, Devon and East Midlands Our Partners: NIHR ARC Greater Manchester , NIHR ARC South West Peninsula , Health Innovation South West , Royal Society for the Prevention of Accidents, Health Innovation Manchester, Later Life Training, Torbay and South Devon NHS Foundation Trust, Leicester-shire and Rutland Sport. Research sites: Devon Integrated Care System (ICS), Manchester combined authority, Leicester, Leicestershire and Rutland ICS, Derby and Derbyshire ICS Starts: 1/10/2021 Ends: 30/9/2025 Lay summary below Falling can cause injury, pain, loss of confidence and independence. This is undesirable for the individual and their families, and places significant demands on health and social care services. Falls are not inevitable. By improving an individual’s strength and balance, alongside skills to help getting up from a fall (should this happen), the likelihood of a fall occurring or having damaging consequences, such as a long lie on the floor, can be minimised. The Falls Management Exercise (FaME) programme is a group-based, face-to-face, six-month exercise programme specifically aimed at improving the strength and balance of people aged 65 and over. Research has shown that FaME results in fewer falls, improved confidence, and reduced fear-of-falling. Despite this, FaME is still not available everywhere across England. More needs to be understood about how best to increase its availability and ensure high quality delivery. To improve our understanding of this, we previously studied FaME’s set-up, delivery and quality in the East Midlands. We learnt a lot about how to get FaME running and showed that the programmes worked outside of a research setting. Using learning from the East Midlands, we developed a guide for implementing FaME called the implementation toolkit . This evidence-based toolkit contains all the information needed to set up and run a FaME programme, from making the initial business case to promoting it to participants. We now want to use this toolkit to see if FaME can be made more available in two new, and very different, regions: Greater Manchester and Devon, and assess whether FaME works in these populations too, particularly if adaptations are made because of Coronavirus. We aim to: 1) Understand how best to increase availability of FaME in two new areas and assess the role that the toolkit plays in this. Using the toolkit we will work with local experts to promote FaME to organisations that decide what health services should be funded locally. 2) Study the delivery of FaME in the new areas and see if programmes work in these populations by measuring improvements in participating individuals. 3) Test ways of maintaining the quality of FaME programmes over time. Working with Later Life Training, a national not-for-profit organisation with expertise in FaME, we will measure the quality of programmes and test what works to make them better. We will use this information to improve the implementation toolkit and develop plans to support national implementation of FaME. Publications Factors influencing fall prevention programmes across three regions of the UK: the challenge of implementing and spreading the Falls Management Exercise (FaME) programme in a complex landscape | Age and Ageing | Oxford Academic https://vimeo.com/616877571

6dc4c269-ddb7-41c3-afd8-8173c69a4651 ADOPTED ActMed-VW - Healthcare professional's experiences of Access to Medication for people on Virtual Wards who are in their last year of life Virtual wards provide acute, hospital-level care in an individual’s own home, rather than in a hospital or hospice. They are also known as Hospital at Home services. We know that virtual wards can care for people who are in their last year of life. For individuals approaching the end of life, control of symptoms requires prompt access to medication. We know access to palliative care medication can be challenging in the community. There have also been reports of difficulty accessing medication on virtual wards; however, it is not known if there are specific issues accessing palliative care medications on virtual wards. This study aims to investigate access to medication for adults on virtual wards who are in their last year of life. We aim to understand the experiences of healthcare professionals so that we can make recommendations on how to improve access to medication in the future. We will ask healthcare professionals working in virtual wards to answer questions in an online survey. We will ask doctors, nurses, pharmacists, and allied health professionals such as physiotherapists to complete the survey. We will ask them about what works well and what does not. We will ask them about the challenges they have faced, and what would help them to minimise or eradicate these. We will also interview 20 healthcare staff. This will include both professionals who completed the survey and individuals who oversee the management of virtual ward services. We will explore in more detail examples of good practice and the processes that need to be in place to ensure straightforward, fast access to medication. We will consult with clinical and policy experts on potential solutions to the challenges identified in the study findings. We will also work with these experts to develop recommendations for policy and practice. Project team includes: Co-PI - Dr Nicola Andrews Co-PI - Prof Sue Latter Co-I Dr Natasha Campling Co-I Dr Sara McKelvie Research Fellow Dr Dan Aze

62657f5f-1a8d-4fc4-8b32-bd364cb93d3a ADOPTED PROJECT - PREMAC 2 STUDY Development and application of Patient Report Experience Measure for patients accessing ACute oncology services: Aim This study will test a newly designed patient report experience measure (PREM) questionnaire for acute oncology (AO) across three NHS Trusts. Objectives The study will test: i) the acceptability of the PREM instrument to patients; ii) how well the PREM questionnaire performs, its validity and reliability, when completed by patients who have received care from different clinical teams; iii) the capability of the PREM instrument to identify variations of patient experience between participating trusts, and; iv) how easily the PREM questionnaire can be used to collect information across several trusts that might deliver services in different ways. Background People with cancer often need to access AO services for serious problems caused by their disease or treatment. Although trusts are required to obtain feedback from patients who receive AO services, there is currently accepted way of collecting this information. A preceding study, the PREMAC study, designed the new PREM questionnaire that we will test in this subsequent study. Design and Methods The study will include three NHS Trusts, and a sample of at least 100 completed responses will be required for statistical analysis from each site. Patients who have accessed AO services will be sent an electronic link to the questionnaire by text message or email, between one and two weeks following their care. Participants will be eligible if they: have a confirmed diagnosis of cancer; are 18 years old and above; have sought urgent care/advice for problems for cancer or its treatment; have accessed AO service via a triage helpline, a bespoke AO unit or via ED. Only anonymised information will be collected from respondents. Study outputs The main study output will be a validated PREM, which can be used to explore and benchmark the quality of AO services at trusts across England with different service delivery models.

b369496b-453f-489e-9d44-7a954ac3f6d7 Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVID to Address and Transform Existing Integrated Care Pathways (STIMULATE) This project is part of a national consortium Contact: Professor Nisreen Alwan MBE , University of Southampton There is evidence that access to Long Covid (Post Covid-19 Syndrome) NHS Care and related care pathways, the nature of those pathways, and patient experience, varies. Research is required to inform diagnosis, care, public health strategies, policy planning, resource allocation and budgeting. It is likewise essential to define the usual care pathway in Post Covid services, and to understand patient presentation, and the effectiveness and cost of care. The STIMULATE-ICP consortium includes: University College London Hospitals NHS Trust, University College London, University of Central Lancashire, LongCovidSOS, UK Doctors #Longcovid , Royal College of General Practitioners, University of Liverpool, Liverpool University Hospitals Foundation Trust, Perspectum, Living With, University of Hull, Hull University Teaching Hospitals Trust, University of York, University of Leicester, University of Exeter, University of Southampton, University of Sussex, Alliance Medical, GE Healthcare, Olink, Francis Crick Institute, NIHR Applied Research Collaboration South West Peninsula, NIHR Applied Research Collaboration East Midlands, NIHR Applied Research Collaboration North Thames, NIHR Applied Research Collaboration Yorkshire and Humber, NIHR Applied Research Collaboration North West Coast, British Heart Foundation Data Science Centre, BHF Data Science Centre, Health Data Research UK, Office of National Statistics, Royal Devon and Exeter NHS Trust, as well as NIHR Clinical Research Network support. Plain English Summary of the health inequalities work within STIMUALTE-ICP: 23 interviews were completed with people with probable Long Covid We found… There was a lack of awareness of Long Covid, its symptoms and the support available for people with Long Covid An assumed lack of awareness of Long Covid within healthcare People with Long Covid symptoms experienced doubt and uncertainty about the cause of their symptoms Experiences of stigma and discrimination were commonly experienced by people with probable Long Covid. This included experiences of age and gender discrimination, experiences of being dismissed, unsympathetic attitudes and social exclusion. People with probable Long Covid reported feeling embarrassment, feeling tainted and/or different to others because of their Long Covid symptoms. In addition, they expected disbelief and/or judgement from others because of Long Covid People with Long Covid were sometimes reluctant to seek care due to worries surrounding possible investigations and medications, or worries about symptoms being wholly attributed to mental health conditions. There were also concerns about burdening the NHS. The nature of Long Covid symptoms made accessing care difficult. Long Covid symptoms can often come and go or fluctuate, and sometimes one symptom may be more prominent than others. This can mean some symptoms can be overlooked by patients and healthcare professionals. Experiences of people with Long Covid are also constitute epistemic injustice, or inequality surrounding creating, interpreting and conveying knowledge. This is due to the lack of awareness and knowledge of Long Covid both in the community and within healthcare. The findings are published here https://onlinelibrary.wiley.com/doi/abs/10.1111/hex.14037 Our recommendations: What we did Research findings from this study and the NIHR funded HICOVE study have been translated into an easily-usable webtool. This tool aims to encourage people with probable Long Covid who have not yet sought help and support from the NHS or other services to do so. It covers topics of self-doubt, stigma and effects on mental health as well as offering resources, tips, and advice on next steps. This tool is primarily aimed at people who may have Long Covid but are not currently accessing care but may also be helpful to those who are. It is also aimed at healthcare professionals, social prescribers, as well as community organisations to raise awareness about the difficulties and stigma people, particularly those from disadvantaged backgrounds, may face when considering reaching out for a consultation or community support. The webtool is available here: Supporting Long Covid Care ( long-covid-care.org.uk ) Where next? We are working on disseminating the Supporting Long Covid Care webtool as widely as possible and evaluating so that we improve it further. See our news article