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71793130-6407-4a7a-8ebf-2af1daf96dd5 COMPLETED: 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.

a95fe10a-8d2a-464a-8d99-2e3067bb89e8 ADOPTED PROJECT: ExACT-CF: Exercise as an Airway Clearance Technique in people with Cystic Fibrosis – A randomised pilot trial ADOPTED PROJECT: ExACT-CF: Exercise as an Airway Clearance Technique in people with Cystic Fibrosis – A randomised pilot trial Principal Investigators: Dr Don Urquhart , Dr Zoe Saynor Co Applicants : Mrs Lorna Allen (Cystic Fibrosis Trust), Professor Steve Cunningham, Professor Ioannis Vogiatzis , Professor Steff Lewis, Ms Aileen Neilson Partners: University of Portsmouth, University Hospital Southampton NHS Foundation Trust, University of Edinburgh, University of Northumbria at Newcastle, Cystic Fibrosis Trust, CF Warriors (Charity) Starts: May 2022 Ends: 31 October 2023 Background: Cystic fibrosis (CF) is the UK’s most common inherited genetic condition and affects more than 10,500 people. The disease causes problems with the movement of salt and water in the body, resulting in sticky mucus building up, mostly in the lungs and gut. Thick mucus in the airways leads to repeated infections which, over time, damage the lungs. Chest physiotherapy is prescribed to loosen and clear sticky thick mucus from the airways and so to help to reduce lung infection. Chest physiotherapy is a routine treatment to keep people with CF healthy. However, many say it is time consuming and a burden. People with CF have asked if doing exercise could have the same effect as chest physiotherapy sessions for helping clear mucus. Exercise could be more enjoyable and less burdensome. Through a recognised priority setting partnership, the CF community recently ranked research to ‘reduce the burden of their care’ and answer ‘whether exercise can replace chest physiotherapy’, as their number 1 and 7 priorities. Surveys show that many people with CF have occasionally chosen to replace chest physiotherapy with exercise for airway clearance, and we recently confirmed this through a UK-wide survey. We now need to know if they would be willing to take part in research that asks some to stop chest physiotherapy and to exercise (with coughs and huffs) instead. New medicine (modulators) have recently become available for many people with CF, bringing dramatic improvements in their health. Some people who have started modulators are considering whether they can reduce or stop treatments – including chest physiotherapy. So, we need to know the effects of stopping chest physiotherapy and determine if exercise can be used instead - our study aims to understand this. Our recent survey in people with CF, their families, physiotherapists and doctors, showed us that many consider hard exercise with coughs and huffs to be able to clear mucus from the airways. We will study 50 people with CF (>12 years old) for 28-days. We will ask half of them to continue their usual care, and half to stop chest physiotherapy and do exercise that gets them breathing deeply (with coughs and huffs) instead. We will see if people are willing to start and continue with such a study and what they think of the study processes. We will also see how stopping chest physiotherapy and replacing it with exercise affects measurements of their lung function. Within the study we will talk with people with CF and members of their CF team to understand their experiences. This information will tell us whether a larger study can answer Publications Safety, feasibility and efficacy of exercise as an airway clearance technique in cystic fibrosis: a randomised pilot feasibility trial | Thorax

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

09039be4-7f54-4e52-b415-7d6e49acfe67 Predicting nurse staffing requirements -validation and scoping extension study (PREDICT-NURSE validation and extension) Chief Investigator: Paul Meredith, Senior Research Fellow, University of Southampton Team: Christina Saville, Senior Research Fellow, University of Southampton Chiara Dall’Ora, Associate Professor in Health Workforce, University of Southampton Zlatko Zlatev, Senior Enterprise Fellow, University of Southampton Peter Griffiths, Chair in Health Sciences Research, University of Southampton Ian Dickerson, PPI Representative Tom Weeks - E Systems Implementation Manager Tom.Weeks@porthosp.nhs.uk Sue Wierzbicki - Lead Nurse - Workforce Sue.Wierzbicki@porthosp.nhs.uk Partners: Hampshire and Isle of Wight Integrated Care Board, Hampshire Hospitals NHS Foundation Trust, Portsmouth Hospitals University NHS Trust, Salisbury NHS Foundation Trust. Start: 1 October 2024 End: 30 September 2025 Our aim We aim to show that a computer algorithm we have developed which uses information that is already collected about patients can provide good estimates of the number of nurses needed on hospital wards to provide safe care for the patients. Background information It is important to have enough nurses to care for patients on hospital wards. If there are too few nurses, patients may take longer to recover, suffer complications, or die, and the capacity of the hospital to cope with new admissions is reduced. Also staff well-being is affected by high workloads and there is more staff sickness. Many hospitals use the Safer Nursing Care Tool (SNCT) to help them manage staffing levels. This involves surveying all the patients in a ward perhaps three times a day. Assessing each patient in this way is an extra nursing task and in itself adds to the workload. We have developed a computer algorithm using data from one hospital which can provide similar estimates of nursing staff requirements to SNCT but we need to check that these estimates would keep patients safe if they were followed. What we will do We shall use data collected for a previous study as input to the algorithm to produce estimates of nurse staffing requirements for each ward shift using information which could be known at the time. We will compare actual staffing with the algorithm’s estimate to see if there is a deficit or surplus of staff. For each admission we will examine how these deficits and surpluses relate to patient outcomes. We will compare using the algorithm to set a threshold for safe staffing with using the SNCT estimates as a threshold. Our comparisons will include looking at how good the methods are for wards with higher numbers of under-served groups such as the over 75s, those with learning disabilities and those with mental health conditions. We will measure the effect of staff shortfalls on the number of staff sickness absences. The performance of the algorithm will be checked using data from a second hospital in the database. We shall work with our partners to find out what tools are used to determine nurse and other staffing requirements on a day-to-day basis in community and mental health settings and what data on care requirements and outcomes is electronically recorded. We will discuss with partners what opportunities, potential benefits and practical considerations there are to implementing a predictive tool of staffing requirements. Communicating results We will write an academic paper, produce an article for the Nursing Times, create a poster for display at conferences, and publicise the results on social media. Involving the public We will involve local PPIE group members in evaluating and commenting on the possible uses of a predictive tool to support decisions in the day-to-day management of nurse staffing levels on wards.

f06fb2ad-c8c9-436f-982c-c278b7185585 ENRICHER – involvEment iN the cRiminal justice system & the ImpaCt on women’s Health dorsEt & hampshiRe Chief Investigator Professor Julie Parkes Professor in Public Health Head of School of Primary Care, Population Sciences and Medical Education Faculty of Medicine University of Southampton, South Academic Block, Southampton General Hospital, Tremona Road, Dr Emma Plugge Associate Professor in Public Health School of Primary Care, Population Sciences and Medical Education Faculty of Medicine University of Southampton, Co-Investigators Dr Donna Arrondelle , Research Fellow, University of Southampton Dr Naomi Gadian, Public Health Specialist Registrar, University of Southampton Donna Gipson, Director EP:IC Consultants Ltd, West Malling, Kent Dr James Hall , Associate Professor of Educational Psychology, University of Southampton Paula Harriott , Head of Prison Engagement, Prison Reform Trust Professor Kathleen Kendall , Professorial Fellow of Sociology as Applied to Medicine, University of Southampton Dr Sara Morgan , Associate Professor in Public Health, Faculty of Medicine, University of Southampton Professor James Raftery , Faculty of Medicine, University of Southampton, Dr Lucy Wainwright , Director of Research, EP:IC Consultants Ltd, West Malling, Kent Starts: 1st April 2023 Ends: 30th September 2024 Summary This study will look at what happens to women’s health and wellbeing when they are imprisoned. The imprisoned women will be women from Dorset and we will compare any changes to changes in women from Hampshire who go to Hope Street instead of going to prison. Hope Street is a charity-funded alternative to prison, available only to women from Hampshire; women live in special accommodation in the community where they are secure and where they are able to access a range of health and social care services. Women who go to prison are often from the poorest communities and they often have many different health problems, particularly relating to their mental health. These health problems are often related to their crimes and so by making sure they get the services they need, this will help their health improve and benefit wider society by helping tackle crime. This study will ensure that this new and unique information is available to those who plan and deliver health services locally. The Southampton research team on this project are carrying out a 5-year evaluation of Hope Street. This means they can use the data that they are collecting as part of this evaluation on the health of women at Hope Street to compare to women from Dorset who are imprisoned. Researchers will collect information on the health and social care needs of the two groups of women at the same time intervals over a one-year period and in the same way. We will then compare this information to look for differences. We will interview the women so that we understand what their experiences are like in prison or Hope Street, and why there might be differences. We will also look at the cost of their care. The information from our study will help the professionals who plan health and social care services and also those who work in criminal justice settings such as prison or probation. Women with experience of imprisonment are part of the eight-person study team. They have helped design the project and will be working with Hope Street women to train them in research. They will also be important in spreading the word about the study. This will enable us to reach not just academic audiences and policy makers through publishing in journals or presenting at research conferences, but also people with lived experience of imprisonment and charities that work in this area. Informing a wide range of people will be important in ensuring that the findings from this study are acted on.

Understanding the psychosocial needs and trajectories of older adults (>64 years) with alcohol use disorder (AUD) from hospital back into community Team: Kinda Ibrahim is a lecturer and a pharmacist at the Faculty of Medicine and the Deputy Lead for the Ageing and Dementia Theme within the NIHR ARC Wessex Jay Amin is Associate Professor in Psychiatry of Older Age at the University of Southampton and an honorary consultant in Old Age Psychiatry at Southern Health NHS Foundation Trust. Sue Latter is a Professor of Health Services Research and a nurse by background and an expert in medicines optimisation research. Simon Fraser is an Associate Professor in Public Health at the University of Southampton. Ruth Bartlett is a Professor at the University of Southampton and Director of the University of Southampton's Doctoral Training Centre in Dementia Care, and a lead coordinator for the ARC Wessex Faculty. Rosemary Lim is an Associate Professor at school of pharmacy, University of Reading. Michelle Board is an Associate Professor in Nursing Older People at the Faculty of Health and Social Science at Bournemouth University. Starts: October 2022 Ends: September 2024 Lay Summary Most people with dementia or mild cognitive impairment (MCI) have multiple chronic conditions and take five or more regular medications (polypharmacy). Polypharmacy in people with dementia/MCI can lead to increased risk of drug interactions, side effects such as falls and cognitive decline, and sometimes hospitalisation and death. Some types of medications (such as strong anticholinergic drugs) can increase risk of developing dementia and cognitive impairment. It is estimated that over £400 million is spent annually in the UK in hospital admissions related to harm from medications. Identifying harmful medications and stopping or switching to safer alternative (deprescribing) has the potential to reduce the risk of developing dementia and improve outcomes for people already living with dementia. However, to date, deprescribing interventions for people with dementia/MCI have focused on specific drug classes (e.g., anti-psychotics) or have been limited to inpatient or nursing home setting. In the UK, it is estimated that 61% of people with dementia live at home where medication is a part of daily living. Most studies also focused on medication-related outcomes (e.g. discontinuation of high-risk medications) rather than patient-centred outcomes, and did not involve the person with dementia and their carer. Therefor it is essential to understand how primary care staff could involve people with dementia/MCI and their caregivers in shared-decision making about stopping medications safely. The aim of this study is to develop a primary care–based deprescribing intervention focusing on increasing shared-decision making targeting people with dementia/MCI and their caregivers. The proposed research will include two phases: First, a search of published literature to understand how effective deprescribing interventions among people with dementia/MCI, with a focus on what works or does not work for this population. Secondly, we will conduct interviews with people with dementia/MCI and their caregivers as well as healthcare professional. We want to understand how deprescribing can be initiated and monitored among people with dementia or MCI in primary care setting and how patients and their caregivers could be involved in decisions about medication taking. Then we will use the information we gather to identify the key elements/factors that make deprescribing and shared-decision making possible in primary care. We will develop an intervention which will then be refined in a future study, subject to funding, through a series of workshops and rapid iterations with key stakeholders to discuss its content, format, style and delivery. Read all Mental Health Hub projects

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9e2c7f6f-813a-4237-9695-46d21cbe9cea COMPLETED: Development, evaluation and provision of an intervention for primary and community NHS staff to help carers and homecare workers supporting people living at home with dementia with their continence. NIHR Three Schools Dementia Research Programme: NIHR School for Social Care Research, NIHR School for Primary Care Research and NIHR School for Public Health Research Team Lead investigator : Dr Cathy Murphy, Senior Research Fellow, School of Health Sciences, University of Southampton Co-i: Prof Mandy Fader, Professor of Continence Technology, School of Health Sciences, University of Southampton Co-i: Prof Miriam Santer, Professor of Primary Care Research, Faculty of Medicine, University of Southampton, NIHR School for Primary Care Research, Bournemouth based GP Co-i: Dr Leanne Morrison, Lecturer in Health Psychology, School of Psychology & Primary Care Research Centre, University of Southampton, NIHR School for Primary Care Research Co-i (PPI): Jane Ward, Alzheimer’s Society Research Network Member, co-founder of Dementia Friendly Hampshire, Patient Research Ambassador Co-i: Prof Jill Manthorpe, Professor of Social Work, Director of NIHR Policy Research Unit in Health & Social Care Workforce, King’s College London – Associate Director of NIHR School for Social Care Research Start date: 1st June 2022 End date: 28th Feb 2024 We found that Healthcare professionals wanted an easy and quick to use intervention to sign-post carers to continence care guidance. Homecare workers would welcome resources aimed at having difficult continence conversations The findings led us to develop the first evidence-based website to support healthcare professionals to provide continence advice to the carers of people living with dementia. The intervention also provides carers with detailed, practical self-management guidance. The website is www.demcon.org.uk A summary of the work can be found in this article: C Murphy, B Bradbury, M Fader, L Morrison, M Santer, J Ward, H Chester. Supporting continence care for people living at home with dementia. 22 APRIL, 2024. Nursing Times What we did with the new knowledge The findings have led to the first evidence-based intervention to support healthcare professionals to provide continence advice to the carers of people living with dementia. The intervention supports healthcare professionals to initiate conversations and then to sign-post carers to detailed, evidence based self-management guidance. The website can be accessed here: www.demcon.org.uk What are we doing next? The project has provided foundational findings for the next phase of work which includes developing a new intervention to support homecare workers to initiate continence conversations with people living at home with dementia. This work (DemCon2) is being funded by NIHR Three School’s Dementia Research Programme and will start Autumn 2024.

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

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

df3a87da-ba5f-40cd-8109-9f23cf0662d9 COMPLETED: Promoting person-centred care using the CHAT&PLAN conversation guide Promoting person-centred care using the CHAT&PLANTMconversation guide Project leads: Professor Jackie Bridges (Professor of Older People's Care, School of Health Sciences, University of Southampton), Dr Teresa Corbett (Lecturer, Solent University) Team members: Professor Jackie Bridges (Professor of Older People's Care, School of Health Sciences, University of Southampton), Dr Teresa Corbett (Lecturer, Solent University), Professor Alison Richardson (School of Health Sciences, University of Southampton), Dr Jane Winter (Macmillan Consultant Colorectal Nurse, University Hospital Southampton NHS Foundation Trust), Start: 1 October 2019 Ends: 30 April 2022 Project Partners: University Hospital Southampton NHS Foundation Trust, Southern Health NHS Foundation Trust, Bournemouth University, Macmillan Cancer Support Lay summary The aim of this Wessex ARC project is to share a conversation guide we have developed through our research. The guide helps health and social care staff talk to older adults who have lots of different conditions. The guide has 8 steps that should be followed in a meeting with people about their needs and personal goals. We call the guide “CHAT&PLAN” and we’d like to make sure that people working in health and social care know about it and use it in their work. This website leads to resources to support people to use CHAT&PLAN in their work. We have a new project underway with the Wessex Cancer Alliance that tests out some new ways of supporting people with cancer, including the CHAT&PLAN. Corbett, T., Cummings, A., Lee, K., Calman, L., Fenerty, V., Farrington, N., Lewis, L., Young, A., Boddington, H., Wiseman, T., Richardson, A., Foster, C., Bridges, J. (2020). Planning and optimising CHAT&PLAN: a conversation-based intervention to promote person-centred care for older people living with multimorbidity. PLOS One . https://doi.org/10.1371/journal.pone.0240516 The following people were involved in the research behind the CHAT&PLAN: Dr Hilary Boddington, Professor Jackie Bridges, Dr Lynn Calman, Dr Teresa Corbett, Dr Amanda Cummings, Dr Naomi Farrington, Vicky Fenerty, Professor Claire Foster, Dr Kellyn Lee, Lucy Lewis, Professor Alison Richardson, Dr Jane Winter, Professor Theresa Wiseman, Alexandra Young

Dr Naomi Klepacz & Professor Jane Ball (School of Health Sciences, University of Southampton) < Back Addressing underlying workforce challenges is essential to meet the nation’s mental health care needs Mental Health Dr Naomi Klepacz & Professor Jane Ball (School of Health Sciences, University of Southampton) What is it like to be part of the mental health nursing workforce? We argue that it is only by understanding the reality of the job – its highs and its lows – that we will be able to grow the mental health workforce and hold on to experienced nurses needed to deliver care well. Demand for mental health services is at an all-time high, yet many people cannot access vital services and face long waits for treatment ( 1) . Nurses comprise one-in-three of the NHS mental health workforce (2) . They are fundamental to providing mental health services and a positive patient experience. However, mental health nursing vacancies represent a third of all nursing vacancies (3) , and while there has been a welcome increase in the number of mental health nurses in recent years, the rate of increase still falls behind that seen in adult and children’s nursing (2) . There are also significant regional differences in mental health nurse staffing that seem disconnected from the level of demand for services (2) . The bottom line is that both now and, in the future, we need more nurses working in mental health – which means expanding supply and ensuring we have the conditions needed to retain the experienced staff we already have. The NHS Long Term workforce plan proposes an investment in expanding training places by 2028/29, with a promised increase of 38% for mental health nursing (4) . A substantial change, but lower than that promised to other fields of nursing. Research has demonstrated the link between nurse wellbeing and patient experience of care, staff and patient safety, sickness absence, job satisfaction and leads to staff leaving the workforce (5) . Physical or mental health, burnout or exhaustion currently follow retirement as the top reason nurses leave the profession (6) . The 2022 NHS Staff Survey reports that 49% of mental health nurses felt unwell because of work-related stress in the last 12 months, 61% came to work despite not feeling well enough to perform their duties, 45% reported often or always finding their work emotionally exhausting, and 28% experienced physical violence from a patient or service user in the last 12 months. In addition, 70% work additional unpaid hours over and above their contracted hours. Therefore, understanding the working lives and wellbeing of the mental health nursing workforce is critical for patient care quality, patient nurses, and the growing nursing workforce. Change is urgently needed to meet the nation’s demand for mental health care, but change requires commitment, investment, and, above all, an understanding of, and sensitivity to, the underlying issues. NHS England made a commitment to the growth and development of mental health nursing (7) , and recommendations from this report together with those from the Nuffield Trust (2) say a more accurate and realistic image of the mental health nursing role is needed, with clarity on career options, work setting and the range of people mental health nurses care for, to challenge false stereotypes. In our research into the working lives and wellbeing of nurses in mental health, we have spoken to some truly inspirational nurses who describe working as a mental health nurse as “the best job in the world”. While both patients and nurses place value on therapeutic relationships (8) , the importance of these relationships appears to be poorly understood by those who have not been touched by this experience (9) . Yet the absence of such relationships in mental health care can impact both patients (who may feel more disconnected, alone or vulnerable) and nurses - who are less likely to feel job satisfaction or take pride in the care provided ( 8 , 10 ). Unlike other fields of nursing, mental health nurses argue that it is this patient familiarity, the knowledge and experience gained through patient interaction, rather than treatment-focused ‘skills’ that make mental health nurses unique and indispensable while also making the role of mental health nurses challenging to define and difficult to evidence. Nurses don’t just deliver the intervention; they are the intervention. This is why we are undertaking a study (with funding from the NIHR ARC Wessex Mental Health Hub ) to provide insight into the work lives, wellbeing and working context of nurses in mental health services so that action can be taken (through local changes and/or national policy) to enable a better experience of work. When nurses feel good about the work they do and are given what they need, the benefits – to staff, organisations, and patients – are many. As part of this work, a national survey of the mental health nursing workforce is currently underway. This survey is open to nurses on the Nursing and Midwifery Council (NMC Register) providing mental healthcare to any patient group, in any setting, and for any health and social care provider. It is completely anonymous and will take 15-20 minutes to complete. This study is supported by the National Institute for Health and Care Research ARC Wessex. The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health and Care Research or the Department of Health and Social Care. Professor Jane Ball Dr Naomi Klepacz References: 1. Care Quality Commission. Rising demand for mental health care [Internet]. 2022. Available from: https://www.cqc.org.uk/publications/major-reports/soc202021_01d_mh-care-demand 2. Palmer W, Dodsworth E, Rolewicz L. In train? Progress on mental health nurse education [Internet]. Nuffield Trust; 2023 May. Available from: https://www.nuffieldtrust.org.uk/sites/default/files/2023-05/Mental%20Health%20nursing%20update_WEB_FINAL.pdf 3. NHS Digital. NHS Vacancy Statistics England, April 2015 - March 2023, Experimental Statistics [Internet]. 2023. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-vacancies-survey/april-2015---march-2023-experimental-statistics 4. NHS England. NHS Long Term Workforce Plan [Internet]. 2023 Jun. Available from: https://www.england.nhs.uk/wp-content/uploads/2023/06/nhs-long-term-workforce-plan-v1.2.pdf 5. Maben J, Adams M, Peccei R, Murrells T, Robert G. Patients’ experiences of care and the influence of staff motivation, affect and well-being. NIHR; 6. Nursing & Midwifery Council. 2023 NMC Registere Leavers Survey (Summary Report) [Internet]. Nursing & Midwivery Council; 2023 May [cited 2023 Jul 10] p. 1–36. Available from: https://www.nmc.org.uk/globalassets/sitedocuments/data-reports/may-2023/annual-data-report-leavers-survey-2023.pdf 7. Health Education England. Commitment and Growth: advancing mental health nursing now and for the future [Internet]. Health Education England; 2022 Apr p. 37. Available from: https://www.hee.nhs.uk/sites/default/files/documents/Commitment%20and%20Growth%20Advancing%20Mental%20Health%20Nursing%20Now%20and%20for%20the%20Future.pdf 8. 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