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18fd758f-b147-4294-acb1-07c88dc1baa9 PUNDIT – Predicting hospital Usage Numbers via a DIgital Twin Principal Investigator: Dr Carlos Lamas-Fernandez , Associate Professor in Business Analytics/ Management Science in Southampton Business School / Faculty of Social Sciences, University of Southampton. Team : Professor Christine Currie , School of Mathematics, Faculty of Social Sciences, University of Southampton. Dr Dan Burns , Innovation Centre, Electronics & Computer Science, University of Southampton. Dr Chris Duckworth , Innovation Centre, Electronics & Computer Science, University of Southampton. Professor Michael Boniface , I nnovation Centre, Electronics & Computer Science, University of Southampton. Professor Peter Griffiths , School of Health Sciences, University of Southampton. Dr Mark Wright , University Hospital Southampton NHS Foundation Trust. Starts: 1 April, 2024 Ends : 30 September 2024 Summary Hospitals in the UK are in crisis with high levels of occupancy. The percentage of occupancy in England during July-September was 88%, and in UHS it reached 92.2% . These levels exceed the safety threshold for hospital occupancy, which sits at around 85%. Together with difficulties to ensure a smooth patient flow across the hospital, this results in adverse effects for patients: elongated hospital stays, increasing the backlog of elective procedures, increasing delays in ambulance handovers and increased mortality. In practice, hospitals try and control high occupancy levels by certain interventions, such as dedicated discharge teams, re-scheduling or cancelling elective procedures or repurposing hospital wards. These measures, however, are reactive, i.e. when the occupancy is already reaching unsafe levels, rather than proactive, that is, when anticipating a high occupancy in the near future. Further, it is not clear whether occupancy levels have an effect on treatment and discharge times, but from frontline clinicians at UHS, there is the hypothesis that higher occupancy could make them longer (as clinicians are busier prioritising the sick over the well patients who could go home), compounding the occupancy issues. Higher occupancy also decreases likelihood of patients being in the optimal location. A related research project (PROCED) has shown early evidence that frequent ward/team changes increase delays in patient discharge. The aim of this project is to investigate the feasibility and build the foundations of a simulation model that can predict accurately future, short-term, hospital bed occupancy to inform interventions. The project will have a special focus on investigating the feasibility of a model to be tailored to use in practice as a “Digital Twin” (DT), which can anticipate hospital occupancy under different scenarios, some of which can reflect proposed interventions.

08639c2e-864e-4386-adf6-510fcbb59d49 Identifying the knowledge gaps of paramedics managing patients with mental health issues Chief Investigators: Dr Ursula Rolfe. Faculty of Health and Social Sciences. Bournemouth University, Dr Natasha Campling, School of Health Sciences, University of Southampton. Implementation lead: Kirsty Lowery-Richardson, Head of Education, College of Paramedics Partners: Bournemouth University, University of Southampton, College of Paramedics CLASS Professional Publishing, Mental Health Education leads in all 11 ambulance Trusts including West Midlands Ambulance Service. Start: 1 October 2024 End: 31 March 2026 Aim of the research: To identify the knowledge gaps of paramedics when responding to people with mental health issues. Background to the research: Many people experience mental health issues in their lives and about 1 in 6 adults in England have a diagnosed common mental health illness. Mental health issues are rising, but rates are rising most for young people. Amongst 17- to 19-year olds rates of mental health illness rose from 10% in 2017 to 26% in 2022. Rising rates of mental health issues combined with pressure on community services mean that that over 1.2 million people are waiting for support and treatment from NHS community mental health services. The result of such high-level unmet demand has fallen on ambulance services and paramedics. England’s ambulance services received 524,485 mental health related 999 calls in 2018-19, but by 2021-22 this increased to 652,720, a rise of 24%. Across England, ambulance staff spend 1.8 million hours annually (or 75,000 days), responding to people with mental health issues. Paramedics express concerns attending to patients experiencing mental health issues because of a lack of education. However, the specific nature of their knowledge gaps that underpin these concerns are not known. Therefore, this research will identify these gaps and make recommendations to inform the future design of effective educational provision, to better support the paramedic workforce in delivering quality care for the rising population of individuals with mental health needs. Design and methods: The study is designed in two phases. First, university-level education (prior to paramedic qualification) and in-practice training (once qualified) from all England’s ambulance services regarding mental health care provision will be analysed. Second, interviews with up to 20 paramedics regarding their knowledge when managing patients with mental health issues will be undertaken. The interviews will use patient cases, informed by real-life examples, to explore paramedic decision-making. Patient, public and community involvement: We have worked with a dedicated group of individuals with lived experience of mental health issues who have received care from ambulance services and paramedics to design the study. The group have all backed the importance of the study, highlighting the need for “ more caring ” by paramedics when attending those with mental health needs. We will continue to work with this group throughout the study. The group will help co-design study documents, such as the interview guide and patient cases for the paramedic interviews. The group will also be given the opportunity if desired to review and input into data analysis during both study phases. Dissemination: Findings will be shared with healthcare commissioners, ambulance services and Universities. The project’s findings will form the basis of recommendations on educational delivery via both ambulance services and Universities, and further research on how best to provide education solutions to the knowledge gaps identified.

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.

bfee6430-aafd-44b2-bd89-074b9c7bf0b9 ADOPTED PROJECT: ADAPT: The cross-sector implementation of NICE-recommended CBT-based interventions for young people in care: Framework Chief Investigator: Dr Rachel Hiller– University of Southampton Project Team Members: Dr Gretchen Bjornstad– University of Exeter, Dr Tim Clarke – Norfolk & Waveney Children and Young People Care Group, Dr Kristian Hudson– Improvement Academy Bradford Teaching Hospital NHS Foundation Trust, Professor John Macleod– University of Bristol, Dr Ruth McGovern– Newcastle University, Dr Hugh McLeod– University of Bristol, Professor Richard Meiser-Stedman– University of East Anglia, Dr Sara Morgan– University of Southampton, Dr Beverley Slater– Bradford Institute of Health Research, Professor Paul Stallard– University of Bath, ProfessorJohn Wright– Bradford Institute of Health Research, Dr Patrick Smith– King’s College London. Organisations Involved: Swindon Borough Council, Bath and North East Somerset (BaNES) Children’s Services, Thinking Allowed specialist-service, Bristol, Newcastle City Council Children’s Social Care, Child and Adolescent Mental Health Services (CAMHS) (East) Background: Young people in care (care-experienced young people; CEYP) have substantially higher rates of mental health difficulties compared to their peers. Their unaddressed mental health needs have been identified as a key driver of a range of poor outcomes that categorise this group. For example, CEYP they are five times more likely than peers to be excluded from school, comprise 50% of the young male prison population, and 25% of the homeless population. Such outcomes are not inevitable. Yet services are often struggling to effectively address the mental health needs of this group, and thus prevent some of these wide-ranging consequences. To begin to address this complex issue, we are proposing a pilot implementation project, working with CAMHS, social care and third- sector mental health services across four target ARCs. Our pilot project aims to address this via overlapping stages that form the essential framework for a full-scale implementation trial. These are: (1) A scoping review and consultation with CEYP, carers, and services to develop an initial implementation framework, based on the consolidated framework for implementation research (CFIR) (2) The development of our implementation resources, including training materials What did we find out? We found that young adults aged 18-25 did not engage with the RADAR/ADAPT programme, and may not engage with perpetrator services, if they do not have motivation to do so. The implications are that this poses a risk to victims, particularly if perpetrators have high risk behaviours. To address this, more work should be done to disrupt high risk individuals and refer them on to workshops that require less time commitment; in order to initiate self-awareness around their behaviors and their impact on others. Given that children were a strong motivation for completing a programme, it seemed almost paradoxical that there were no specialist services made available for children within the DAPP model. Although there is compelling evidence to suggest that men changed their behaviours following the programme, police reoffending data suggests that, for a minority of individuals, more work is required to fully embed positive behaviours. A mentoring service may support such aims. To further support evidence on behavioural change, long term outcomes related to victim harm should be measured; for example, through a short questionnaire filled out by current or former partners. The RADAR/ ADAPT programme is specific to the domestic abuse experienced between intimate partners within heterosexual relationships. The implications are that a number of individuals may not find the programmes appropriate to their context. Therefore pilot programmes should be developed to tackle different relationship dynamics and types of abuse, including lesbian gay bisexual transgender queer (LGBTQ) relationships, and Elder Abuse. Finally, to full achieve a community coordinated response, and make the most of the resources available, pathways of referrals and a mutual understanding of roles and responsibilities should be clearly set out, to cover both statutory and non-statutory organisations. What did we do with this knowlege? •The findings from the research were communicated with the commissioners of future services in Domestic Abuse in Hampshire. •The next commissioned service considered the findings of the research in the tender. •For example, given the risk of non-engagement of younger adults, a specific service for 18-24 year olds, was set up that working on the specific needs of this population group. •The findings added to the limited knowledge around voluntary community perpetrator programmes. •It was published in the Open Access journal PloS ONE https://doi.org/10.1371/journal.pone.0218408 •Dr Sara Morgan was interviewed alongside Tracy Rutherford (Hampton Trust) on the Patrick Sisson show (BBC Radio Solent) Where next? •The work on ADAPT has led to further research in this area through existing partnerships, including a national evaluation of CARA •We have continued relationships with police partners who were interested in further evaluation work, which led to co-funding of other projects including Operation Foundation and MASP •Personally, Chief Investigator is interested in the findings around younger perpetrators, and how to engage them better in the health and social care system, and improve their life-chances. •Where many perpetrators on ADAPT have experienced domestic abuse as children, and they themselves have children, I’m interested in pursuing work around preventing the intergenerational transmission of domestic abuse. Publications Baseline characteristics and outcomes of the main perpetrator programme within the Hampshire Domestic Abuse Prevention Partnership, UK: A mixed methods study | PLOS One

6e7ee8b2-1a6e-457b-9b3c-d7c31dc9079f ADOPTED: CEDA ‘Making the invisible visible’: identifying and responding to unpaid carers who experience domestic abuse from end-of-life care recipients Chief Investigators: Dr Michelle Myall , School of Health Sciences, University of Southampton and Dr Sandi Dheensa, University of Bristol. Team: Dr Susi Lund, Dr Sophia Taylor and Dr Becky Foster , School of Health Sciences, University of Southampton. Professor Siobhan O'Dwyer, University of Birmingham. Ms Katy Styles, We Care Campaign. Ms Marion Goodchild, Public and Patient Contributor. Summary Globally, home is most people’s preferred place of death. This relies on physical, emotional and practical support from unpaid carers e.g., family members, friends, or neighbours for people at the end-of-life (EOL) who are recognised as the most important factor in delivering at-home end-of-life care (EOLC). In England approximately 500,000 people provide unpaid EOLC. Half of unpaid carers provide up to 19 hours of care per week , increasing to an average of 70 hours at EOL. Unpaid carers make crucial contributions to EOLC, off-setting health service costs and enabling patient choice. Many carers do not identify as ‘carers’ and the caring role is often unplanned. Whether they choose the role or not, the demands of EOLC often exceed carers’ capacity to cope and are associated with poor physical and mental health, social isolation and financial insecurity. For some carers, suicide and homicide-suicide can seem like the only way out. There is clear evidence that EOL carers experience worse outcomes compared with those who care for someone who is not at EOL, and these outcomes increase in line with number of care hours provided and severity of the person’s illness . These negative consequences are compounded for EOL carers who are female, older, disabled, migrants, black, or minority ethnic. While the general toll of caring is well documented, little attention has been paid to the impact of caring or a person at EOL who is, or has previously been, abusive. Research that understands carers survivors’ experiences, and informs policy and practice for improved support is imperative. This research is a 24-month qualitative study comprising three linked phases. A qualitative approach will enable a sensitive and nuanced exploration of complex experiences and the relational aspects of domestic abuse (DA) in EOL caring relationships . We will work in partnership with people with lived experience, HSCPs, specialist DA organisations and key public service representatives through a Community of Practice (CoP) to co-produce knowledge and guidance to help HSCPs identify and respond to carer-survivors and generate recommendations to inform policy and practice. This study will generate important new insights into carer-survivor experiences. This is essential to ensure improved outcomes and to address gaps in support for carer-survivors during the EOL period and through to bereavement. The study will also produce resources for (Health and Social Care Professionals)HSCPs to identify and respond to DA, with the goal of improving carer experience, wellbeing, and safety. The study is part of a programme of research focused on domestic abuse where it co-exists with long-term/life-limiting illness and end of life. In 2024, we co-developed the DALLI toolkit, a resource for health and social care professionals working with people at end-of-life who are at risk of domestic abuse. The DALLI toolkit is hosted by Marie Curie and has been adopted in hospices, local authorities, integrated care boards and domestic abuse services in the UK and has attracted international interest. If you would like to find out more please click here: COMPLETED: Domestic Abuse and Life-Limiting Illness: identifying and supporting adults at risk (DALLI Study)

54d3d6a4-2f97-4fa8-8c83-e41613f3b35d Co-POWeR - Consortium on Practices of Wellbeing and Resilience in BAME Families and Communities Principal Investigator: Professor Iyiola Solanke, University of Leeds Team: Professor Maria Stokes, School of Health Sciences, University of Southampton; Professor Sabu Padmadas, School of Economic, Social & Political Sciences, University of Southampton; Professor Monica Lakhanpaul, Institute of Child Health, University College London; Professor Claudia Bernard, Professor of Social Work. Department Social, Therapeutic and Community Studies, Goldsmiths College; Professor Shirin Rai, Politics and International Studies, University of Warwick; Professor Raminder Kaur, School of Global Studies, University of Sussex; Professor Gargi Bhattacharyya, Law and Social Sciences, University of East London; Professor Florence Ayisi, Faculty of Creative Industries, University of South Wales; Professor Anna Gupta, Department of Social Work, Royal Holloway, University of London. Duration: 18 months Summary Two viruses - COVID-19 and discrimination - are currently killing in the UK (Solanke 2020), especially within BAMEFC who are hardest hit. Survivors face ongoing damage to wellbeing and resilience, in terms of physical and mental health as well as social, cultural and economic (non-medical) consequences. Psychosocial (ADCS 2020; The Children's Society 2020)/ physical trauma of those diseased and deceased, disproportionate job-loss (Hu 2020) multigenerational housing, disrupted care chains (Rai 2016) lack of access to culture, education and exercise, poor nutrition, 'over-policing' (BigBrotherWatch 2020) hit BAMEFC severely. Local 'lockdowns' illustrate how easily BAMEFC become subject to stigmatization and discrimination through 'mis-infodemics' (IOM 2020). The impact of these viruses cause long-term poor outcomes. While systemic deficiencies have stimulated BAMEFC agency, producing solidarity under emergency, BAMEFC vulnerability remains, requiring official support. The issues are complex thus we focus on the interlinked and 'intersectional nature of forms of exclusion and disadvantage', operationalised through the idea of a 'cycle of wellbeing and resilience' (CWAR) which recognises how COVID-19 places significant stress upon BAMEFC structures and the impact of COVID-19 and discrimination on different BAMEFC cohorts across the UK, in whose lives existing health inequalities are compounded by a myriad of structural inequalities. Given the prevalence of multi-generational households, BAMEFC are likely to experience these as a complex of jostling over-lapping stressors: over-policed unemployed young adults are more likely to live with keyworkers using public transport to attend jobs in the front line, serving elders as formal/informal carers, neglecting their health thus exacerbating co-morbidities and struggling to feed children who are unable to attend school, resulting in nutritional and digital deprivation. Historical research shows race/class dimensions to national emergencies (e.g. Hurricane Katrina) but most research focuses on the COVID-19 experience of white families/communities. Co-POWeR recommendations will emerge from culturally and racially sensitive social science research on wellbeing and resilience providing context as an essential strand for the success of biomedical and policy interventions (e.g. vaccines, mass testing). We will enhance official decision making through strengthening cultural competence in ongoing responses to COVID-19 thereby maximizing success of national strategy. Evidenced recommendations will enable official mitigation of disproportionate damage to wellbeing and resilience in BAMEFC. Empowerment is a core consortium value. Supporting UKRI goals for an inclusive research culture, we promote co-design and co-production to create a multi-disciplinary BAME research community spanning multi-cultural UK to inform policy. CO-POWeR investigates the synergistic effect on different age groups of challenges including policing, child welfare, caring and physical activity and nutrition. WP1 Emergency Powers investigates these vague powers to understand their impact on practices of wellbeing and resilience across BAMEFC. WP2 Children, Young People and their Families investigates implications for children/young people in BAMEFC who experience COVID-19 negatively due to disproportionate socio-economic and psychosocial impacts on their families and communities. WP3 Care, Caring and Carers investigates the interaction of care, caring and carers within BAMEFC to identify how to increase the wellbeing and resilience of older people, and paid and unpaid carers. WP4 Physical Activity and Nutrition investigates improving resilience and wellbeing by tackling vulnerability to underlying health conditions in BAMEFC. WP5 Empowering BAMEFC through Positive Narratives channels research from WP1-4 to coproduce fiction and non-fiction materials tackling the vulnerability of BAMEFC to 'misinfodemics'.

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.

26c4cdf6-472a-4d3e-94e8-fa2c11941202 Neuro Digital: From Attitudes to Strategies Principal Investigator: Professor Chris Kipps Team members: Dr Sarah Fearn, Dr John Spreadbury, Dr Rachel Chappell, Dr Corine Driessens Project Partners: University Hospital Southampton NHS Foundation Trust, University of Southampton Starts: 01 October 2021 Ends: 30 September 2023 Background The COVID-19 pandemic has changed the way neurological care is delivered to involve greater use of digital technology such as videocalls, smartphone apps or online platforms. University Hospital Southampton (UHS) has been developing its own electronic personal health record and self-management platform called My Medical Record. This online care platform offers patients more control over their healthcare by allowing them to: access their clinical letters and appointments in one place message their clinical teams for advice read relevant information on their condition monitor and share outcomes. Data from the platform, however, indicates differences in uptake and use amongst different groups of patients and healthcare professionals. Existing research also tell us that there are still important issues to understand around the uptake and use of digital technology in neurological care and long-term conditions more generally. Aims and Methodology The main aim of the research is to understand how to optimise the use of digital health technology in neurological conditions ( multiple sclerosis, Parkinson’s disease or Atypical Parkinsonian Syndrome (APS), headache, epilepsy, motor neurone disease or other neuromuscular disorder, Huntington’s disease, atypical or early onset dementia ). This will include how to optimise the use of My Medical Record for patients at UHS. The research will involve three interrelated pieces of work or ‘work packages’: Work Package 1 will use interviews and focus groups with neurological patients, carers, and healthcare professionals to investigate attitudes toward digital health technology and My Medical Record. Work Package 2 will use surveys with neurological patients to investigate relationships between personal and clinical characteristics and how people use digital health and My Medical Record. Work Package 3 will use the findings from Work Package 1 and 2 to produce some strategies to support people with neurological conditions to use digital health and My Medical Record. The strategies will be produced together with patient, carer, and healthcare professional groups in co-production workshops. Outcomes The NHS has highlighted the greater use of digital health technology as a way to improve the delivery of care over the next 10 years. The findings from the research will help us to better understand how to promote, optimise and support the use of digital health for people with neurological conditions, including the use of My Medical Record. Taking Part If you would like more information about the study or are interested in taking part, please contact Dr Sarah Fearn via email at S.Fearn@soton.ac.uk or Dr John Spreadbury on 07876818404 or jhs101@soton.ac.uk . What did we find out? With regards to personal characteristics affecting use: We found that older age, lower education, lower income, lower literacy and lower patient activation* were all associated with lower digital health technology uptake and use and more negative views. * Patient activation is a person's level of knowledge, skills and confidence to manage their condition(s) We found that gender and health status were not associated with uptake, use* or views. * Exception of health status and direct contact with healthcare team when participant has a specific issue Whilst we found that symptoms associated with having a neurological condition impacted the use of digital healthcare, we found that people with a neurological condition had access to digital healthcare (e.g. the tech / internet connection etc) comparable to the general population. We also held three co-production workshops to identify strategies that could support or promote the use of digital health technology amongst people with neurological condition. • These were the suggested strategies: What difference can this new knowledge make? Understanding the attitudes towards, and use of, digital health technology for people living with neurological conditions, their carers and their HCPs allows us to identify areas where more support might help promote and improve use. Identifying personal and health characteristics associated with more negative views and / or lower rates of use can help us to identify those more likely to need, or benefit from, additional support. Co-designing strategies to help support and promote the use of digital health technology for people living with neurological conditions, their carers and their HCPs, allows us to create support mechanisms that have been co-developed with the users themselves. Why is this important? The number of people with a neurological condition is rising, with around 17 million cases in the UK. Approximately 4% of NHS funding goes to neurology care. The use of digital health technology offers an opportunity The NHS Long Term Plan highlights the use of digital mechanisms as key enablers to improve NHS care delivery over the next 10 years. The use of digital health technology has the potential to help reduce variation or inequality in care, make care more integrated or joined up, identify people at higher risk of poorer outcomes, and promote self-management. It can also support clinicians to be more efficient, freeing up time for the sickest patients. Identifying factors that promote self-management and well-being could improve patient diagnosis and quality of life, reducing care requirements from the NHS. Reducing unplanned GP and hospital visits could improve patient quality of life and reduce resources spent by the NHS. Identifying the frequency and impact of fatigue and ways to manage it could improve patient and reduce resources spent by the NHS. Our findings can help to improve support to people with neurological conditions to use digital health technology. It can do this by: Understanding the benefits and challenges of use Identifying those most likely to need or benefit from additional support Co-developing implementable strategies to support or promote use What Next? We will be using the findings from this study to: -Publish academic publications -Present at medical conferences -Present to groups of people with neurological conditions -Present to national support organisations -Present to ICB (digital transformation work programme); UHS (IT); Neurological Alliance -Inform the Optimising Outpatients project, which aims to create recommendations for the use of remote care in neurology outpatient services. We are continuing to analyse the data and disseminate findings to a wide audience.

c1c3e509-fcbe-4039-a8f6-143f962aecbd Improving community health care planning Improving community health care logistics using Operational Research Principal Investigator: Dr Carlos Lamas-Fernandez Team members: Dr Carlos Lamas-Fernandez, (Research Fellow in Operational Research, University of Southampton), Professor Peter Griffiths (Chair of Health Services Research. University of Southampton), Dr Antonio Martinez-Sykora (Associate Prof of Business Analytics. Southampton Business School, University of Southampton), Dr Tom Monks (Associate Professor of Health Data Science, University of Exeter) Start: 1 October 2019 Ended: 30 September 2021 Partners: University of Southampton, Solent NHS Trust and Abicare Lay summary Operational Research (OR) is the application of computer and mathematical modelling to support decision making. In health services research, OR aims to improve patient outcomes, increase efficiency and enhance health professionals and citizens understanding of how an NHS service achieves good performance. In this study, we will use OR to improve the quality of patient care by supporting community nursing teams organise how they visit people in their own home. What did we acheive? We found that it is possible to develop algorithms that create routes and schedules automatically for district nurses. These algorithms can incorporate many practical constraints that nurses encounter during planning, and produce solutions that are optimised to use their time efficiently. We found out that, with minor modifications, the algorithm can also support social care workers in a similar manner. What difference can this new knowledge make? These algorithms are a stepping stone that bring closer the academic research (typically on idealized problems that do not work on practice) to the reality of nurses that currently organise their workload on a laborious manual process. Both their planning time and the extra time spent on the road (e.g. by doing a route larger than it could have been) can be saved and utilized to care for patients. Why is this important? Patients will benefit from a more efficient workforce, who can as a result have more time to care for them. Further, they might also benefit from better planned visits which might include their preferences. Care providers can use these kind of tools to plan their workload more efficiently, save costs on their operations and reduce the burnout of the nurses in charge of doing manual planning. Policy makers can run these kind of tools to test hypothetical scenarios (e.g. how does service delivery change with an increase of the demand, when we hire more district nurses or if we train part of our staff?). Care providers can also assess What's next? We continue working to improve our algorithms and liaise with social care companies to explore how they can be used in practice. We are looking into integrating them as demand estimation tools in other relevant problems, such as complex discharge from hospital. Publications https://www.nursingtimes.net/news/community/home-healthcare-are-nurses-wasting-their-time-on-the-road-26-04-2021/ A flexible mathematical model for Home Health Care Problems - ScienceDirect Useful Models (Open source): Reproduced exact models from the literature: https://github.com/c-lamas/hhcrsp Our own contribution: https://github.com/miguelreula/MILP_HHCRSP Synthetic Datasets: https://github.com/c-lamas/instances_hhcrsp

00ac00f7-6a45-413d-9354-92f1eb973632 Testing the effects of food product placement on customers’ visual attention and intended product purchases: a randomised trial in a virtual supermarket setting (Phase II) Principal Investigators: Janis Baird and Christina Vogel, Professor of Public Health and Epidemiology and Principal Research Fellow in Public Health Nutrition respectively, MRC Lifecourse Epidemiology Centre, University of Southampton Team: Dr Sarah Muir, Senior Research Fellow, University of Southampton Dr Sarah Crozier, Senior Statistician, MRC Lifecourse Epidemiology Centre, University of Southampton Dr Hayward Godwin, Associate Professor of Psychology, University of Southampton Professor Marcus Munafo and Dr Olivia Maynard, Bristol University Ravita Taheem, Southampton City Council, Sure Start Children’s Centres Started: 1st March 2022 Ends: 30th September 2024 Background Poor diet is linked to an increased risk of obesity, diabetes and heart disease. Most adults in England consume too much salt, saturated fat and free sugar, and do not eat the recommended five daily portions of fruit and vegetables. People with lower education and income levels are more likely to have poor diet and to experience health problems as a result. Women of childbearing age are primarily responsible for domestic food tasks such as shopping and cooking, and their diets are closely linked to those of their children. Most families buy their food from supermarkets and their food choices can be influenced by placement of items in-store and by promotions. Our research This project follows on from COMPLETED: Testing the effects of food product placement on customers’ visual attention and intended product purchases: a randomised trial in a virtual supermarket setting (Phase I) We want to find out how the placement and packaging of healthy and unhealthy foods influence the foods that women choose to buy. We will do this by creating a ‘virtual’ supermarket layout that participants will interact with on a computer screen. We will recruit women attending Sure Start Children’s Centres in Hampshire and those whose children attend early years settings. Hampshire is a county within the Wessex region with some relatively deprived areas. We will choose centres and early years settings located in areas of higher deprivation. Local data suggests that 70% of families with young children are engaged with the centres. Women using the virtual supermarket will be shown images of healthy and unhealthy foods and non-food items that are placed in noticeable locations in the supermarket like checkouts. We will measure the specific aspects of the images women look at using experimental techniques such as eye tracking, which records their gaze point and gaze duration. The eye tracker is positioned close to the computer screen allowing it to record where women look. We will then ask women to tell us the products that they saw for sale, the name of the products they considered purchasing, and aspects of the supermarket that took their interest, and why. Our findings will tell us how people respond to the placement and packaging of different types of food products and whether these reponses differ if families are poorer or more wealthy. These findings help us to design ways to layout supermarkets to help all families eat more healthy foods. Our research will begin in March 2022 and end in late 2022. We will share the findings from our study with local families attending Sure Start Children’s Centres and early years settings. We will inform local and national government employees about our findings which could help to refine current government policies to address childhood obesity. The Study • 68 mothers took part in an eye-tracking study at the University of Southampton. •The women viewed scenes from a virtual supermarket which showed healthy, unhealthy and non-food products. •Scenes focused on the areas in a store where most shoppers usually pass through including the store entrance, end-of-aisles and checkouts. •Eye tracking software captured their eye movements to measure their attention. Participants were also asked to click on items on the screen that they wanted to purchase. •Twelve women also took part in interviews. mothers took part in an eye-tracking study at the University of Southampton. What did we learn? •We compared women’s attention to healthy, unhealthy and non-food items by showing them images of products side by side. Women showed higher levels of attention to healthy products over unhealthy and non-food items. Healthy products were viewed for 0.10 more seconds than unhealthy products and 0.15 more seconds than non-food items. The eye-tracking study also showed that the women had higher intention to purchase healthy foods over unhealthy and non-food items. Interviews with the women showed they used strategies like shopping lists and avoiding aisle ends to avoid unhealthy purchases. They wanted more healthy snacks or products they might have forgotten (such as paracetamol or batteries) at checkouts. What difference can this new Knowledge make? Supermarkets usually place unhealthy foods in noticeable places to make profits. Replacing these unhealthy foods with healthy or non-food items will just as likely, if not more successfully, lead to purchases. This can help families lead healthier lives. Why is this important for patients, health and care providers and policy makers? Placing unhealthy foods in noticeable locations can lead to impulse purchases of foods that can lead to obesity. Our study shows that women do not intend to buy these foods and would prefer healthier alternatives. Since 2022, UK policy has banned the placement of some unhealthy foods at noticeable locations in supermarkets. This research provides evidence that customers are likely to support this policy as they would like to buy healthy and non-food items from these locations. What Next? We are creating an infographic to share our findings with families via Sure Start Children’s Centres, Facebook and local schools. These results support our ongoing evaluation of the Food (Promotion and Placement) Regulations. Data will be shared in ongoing conversations with local authorities and via an academic publication. We have received funding to expand our study from mothers to young people. Adolescence is a time when young people may start to make independent food purchases. We aim to further understand what environmental factors influence young people’s purchases on their journey to and from school.

Justin Strain < Back Thinker, sailor, author, physio Justin's journey so far.. Justin Strain Justin Strain I began my healthcare career a little later than most. At the age of thirty, after a short career in the Royal Navy, I took my first steps into the University of Southampton’s School of Health Professions. I was interested in research from day one. The importance of evidenced-based practice was drummed into us throughout our time at university. From the moment we first wielded a tendon hammer or a stethoscope we were encouraged to ask ourselves those all-important questions: What is the best treatment? Does it work? Why am I doing this? Starting out as a musculoskeletal physiotherapist, I threw myself into clinical practice, desperate to learn every treatment technique and test I could get my hands on. I believed that being a great clinician was about perfecting those tricky manual techniques and learning everything there was to know about anatomy. Or so I thought. Thinking differently Later, as I developed in confidence, I began to think differently about my practice. It seemed to me that what made most difference to my patients was the therapeutic relationship. Understanding the patient’s experience and learning to listen more and communicate better (and sometimes talk less!) started to seem more important than having the biggest toolbox of treatment techniques. Specialising in pain management helped me to appreciate how peoples’ experiences of health-conditions and healthcare were shaped by a complex web of social and personal interactions, making each person’s experience unique to them.The need to understand these unique experiences drew me to qualitative research. I wanted to go further than comparing different interventions. I wanted to understand the stories of the people at the heart of those interventions – our patients. The importance of narrative was not new to me. In my non-clinical life, I write children’s novels – I’ve written two so far and I’m working on a third. In my novel writing, I enjoy the magic of exploring fictional worlds from other peoples’ perspectives. I’ve always found that what brings a novel to life is the personal connection between the reader and the characters. I wanted to apply a similar approach to understanding patients’ stories - listening to, understanding and recording other peoples’ perspectives, and acknowledging the role of the researcher and the reader in interpreting those perspectives. While I was taking my first tentative steps towards qualitative research, the world of healthcare research was changing. The n=1 campaign was gathering momentum, and recognition of qualitative research was increasing. I wanted to get more involved, and found myself looking for the right opportunity. Then, at the beginning of 2020, the world turned upside down with the advent of the COVID 19 pandemic. Along with many other things, the COVID 19 situation has highlighted the need for research – to explore the impact of immediate responses to the crisis, and also to understand how the pandemic will influence longer term changes in how healthcare is delivered. One of those long-term changes is likely to be the proliferation of online healthcare. The plethora of online health interventions now on offer enables people to access consultations and courses that might previously not have been available to them, in a safe, socially distant way. I felt this area was worthy of more exploration, and I wanted to listen to the stories of service users, to understand how these changes had impacted on their experiences. I resolved to start a research project looking at patients’ experiences of online pain management in our own service, but I was struggling to find the time - alongside a busy job in clinical practice, dealing with redeployment and the current challenges of COVID 19, and being dad for our two wonderful children. The NIHR ARC Wessex Clinical Academic Internship has given me that time. It has enabled me to build and apply my skills in research as part of my clinical job, making a difference to how I can support patients within my service. So where am I now? I am in the early stages of my project – a systematic review of qualitative literature about patients’ experiences of online pain management, combined with semi-structured interviews with patients who have completed the online pain management programme within our own service.As well as time, the Clinical Academic Internship has provided a network of similarly minded people, interested in research and qualitative exploration of issues. The excellent events run by NIHR ARC Wessex have introduced me to new research concepts and skills. My supervisors, Dr Euan Sadler and Dr Lindsay Welch , have been extremely supportive and with their help my skills and confidence are growing. I am planning to complete my project in Autumn this year and I am hopeful that this will lead on to a pre-doctoral, and eventually a doctoral fellowship with NIHR ARC Wessex in the future. Dr Euan Sadler is an Associate Clinical Professor of Older People and Frailty within Health Sciences at the University of Southampton. Dr Lindsay Welch is a Lecturer in Adult Nursing and a Researcher in long term conditions. Previous Next

c5ca53e9-5f1d-4394-8679-3abfad5e1fe1 WHELD: Training care home staff to improve well-being and mental health of dementia residents led by NIHR ARC Peninsula and working with NIHR ARC South London, NIHR ARC East Midlands, NIHR ARC East of England, NIHR ARC North East North Cumbria, NIHR ARC North West Coast and NIHR ARC Yorkshire and Humber Implementation of evidence-based cost-effective training for care home staff to improve Wellbeing and mental HEaLth for care home residents with Dementia and reduce unnecessary sedative medications (WHELD into Practice) Principle Investigator: Professor Clive Ballard Team members: Joanne McDermid, Jane Fossey, Barbara Woodward Carlton, John-Paul Taylor, Louise Robinson, Martin Orrell, Clare Hulme, Sube Banerjee, Esme Moniz-Cook, Dag Aarsland, Annette Boaz, Clarissa Giebel, Caroline Watkins, Jo Day Partners: NIHR ARC South West Peninsula ARC, University of Exeter, NIHR ARC Yorkshire and Humber, NIHR ARC East Midlands, NIHR ARC East of England, NIHR ACR South London, NIHR ARC North West Coast , NIHR ARC North East and North Cumbria, University of Plymouth, University of Newcastle, University of Hull, King’s College London, University of Nottingham, South West AHSN, Pendennis Care Home, Devon Partnership NHS trust, Alzheimer’s Society. Research sites: University of Exeter, University of Newcastle, University of Hull, King’s College London, University of Nottingham, University of Liverpool Starts: 1/09/2021 Ends: 31/03/2023 Lay Summary WHELD is an evidence-based person-centred training programme which, in 4 clinical trials involving 2349 care home residents with dementia, demonstrated benefits in well-being and mental health and a reduction in sedative medications across London and Buckinghamshire. No similar programme has been successfully implemented in the UK or elsewhere. Nationwide implementation would have a major impact on well-being among the most vulnerable people with dementia. Lead ARC South West Peninsula with implementation sites also in East Midlands, East of England, North East and North Cumbria, North West, and Yorkshire and Humber ARCs WHELD intervention resources have been optimized for implementation, based on the results of our recent COVID WHELD programme. WHELD will now be implemented in 75 care homes in ARC regions where WHELD has not previously been delivered. Implementation evaluation will identify implementation enablers and barriers, fidelity, reach and buy-in, and provide illustrative case studies. Engagement of PPI representatives and stakeholders to Develop Real World Implementation Plan will be integrated throughout the programme. Key stakeholder groups for this work will include commissioners, senior representatives from Integrated care system organizations, representatives from the AHSNs in the different ARC regions and care home owners/senior managers. A series of dissemination activities, including stakeholder workshops, will enable the development of a plan for scaling up the implementation to national level and any required adaptations to WHELD resources. Progress by October 2022: The digital materials for the programme have been optimized. The programme has IRAS approval and CRN adoption. We currently have 19 participating care homes, with a goal of completing recruitment by the end of March 2023. The first PPI and stakeholder workshops have been completed, with further workshops through the autumn and in the New Year.