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Rajneesh Kaur and Eloise Radcliffe < Back PPI reflection on experience in attending an academic conference "Prescribing and deprescribing is something we do to patients so their viewpoint does matter." Rajneesh Kaur and Eloise Radcliffe Picture: Kinda Ibrahim, Eloise Radliffe, Nina Fudge, Jalpa and Rajneesh Kaur In September 2024 I attended an International Conference on Deprescribing in France (ICOD2). I'd been looking forward to this event since first coming to know of it about a year before. When registering for the conference it stated that they welcomed all 'researchers, clinicians and teachers in the deprescribing field'. This prompted me to email the organisers to ask if I could attend as a non-healthcare professional. They were very welcoming and reassured me that anyone can attend. I was excited not only to see what was happening at the cutting edge of deprescribing but also because I was going to meet the Southampton team in person for the first time at the conference. We had communicated over Teams before but the conference was a great way to meet each other in person. We recognised each other straight away and were in close company over the two days at the conference. The actual content of the conference reconsolidated a lot of what I had learnt about deprescribing so far. It was great to see leading figures deliver live and to be able to ask questions and have conversations with them. When mingling in the workshops and over lunch, people were interested to gain our perspective — I was attending with a good friend of mine who is also a non-healthcare professional like me, but as she is a solicitor, the healthcare professionals at the conference seemed very interested in the legal angle of deprescribing when speaking to my friend. This legal area does need exploring I feel. The viewpoint of patients and carers seemed like something the healthcare professionals valued, yet I felt it was under-represented in the conference. Prescribing and deprescribing is something we do to patients so their viewpoint does matter. I enjoyed listening to the presentation from David Gardner in particular, who shared a patient's experience, with the patient (George) interacting live on the call. This really brought to life how deprescribing can make a difference. Bringing the patient's perspective forward can bring inspiration and motivation to healthcare professionals to be more comfortable with stepping into the unknown and trying something new. I also appreciated that the conference organisers were trying to be open and ethical about their funding, especially pleased that they were not accepting funding from pharmaceutical companies. This made it seem OK that we didn't have any extravagant lunch arrangements, I'd rather that and keep the soul of the conference alive. Also, my friend and I were humbled and surprised to see that every other person at the conference was a pharmacist. It was almost as if after working with medication so closely, these pharmacists realise the harm as well as the good that medicines can do and therefore have come to the conference to understand and acknowledge the importance and challenges of deprescribing. Although deprescribing should be a part of prescribing, it is practised far less than prescribing. In fact, I would say that the benefits of deprescribing are just now being realised and are not mainstream at all. As a result, it seemed very challenging when I first set out looking for pathways to come off medication safely and only then eventually even came across the term deprescribing. The conference was international and it opened doors to meet people from other countries who were on the same page. I especially remember my encounter with a researcher from Denmark who said something very profound, she explained that it's not the patients that need educating, if we make a safe space where people can be deprescribed from medication — they will come. This researcher had struggles with a loved one who is on medication. This conference was a great platform to network and strengthen beliefs in deprescribing. It was only the second international conference ever held on this topic and I am very much looking forward to ICOD3 Eloise: One of the highlights of attending the International Conference on Deprescribing in Nantes, France, was meeting Rajneesh in-person, our highly valued and very engaged Patient and Public Involvement (PPI) team member. She has been a PPI group member of the ARC Wessex-funded MODIFY study (Medication review and deprescribing intervention for older people living with frailty in primary care) and is now chairing the PPI group for a new ARC Wessex-funded study DOMINO-HF (Deprescribing and medicines optimisation in older people with heart failure). I had previously only met her online and the conference was a great opportunity to talk in-person about the presentations and workshops by international leaders in the field of deprescribing and discuss Rajneesh’s ideas for future projects. The conference was a very welcoming and supportive environment and I would definitely agree with Rajneesh that more patients and caregivers should be represented at the conference, and will hopefully be encouraged to attend and participate in the next one, ICOD3 in 2 years time! Previous Next

5464c879-04a7-47dc-8751-6ab5a9ad6d1c ADOPTED: Incidental Interaction: Novel Technology to Support Elders-as-Athletes through Augmenting Everyday Interactions Lead: Professor M.C Schraefel Team: Professor C T Freeman, Dr M B Warner Start date: October 2022 End date: January 2024 Partner organisations: Abri Different Strokes Southampton Solent NHS Trust Z-Health Performance Solutions Background Elders classically are framed as people who are inevitably getting weaker, losing muscle and bone mass, cognitive capacity, and inevitably requiring care to manage simple "activities of daily living" such as walking, feeding, toileting and bathing. These effects limit their capacity to live independently and healthily in their own homes.To address this decline, research in even just the past five years has been looking for new molecules and therapies to slow or reverse aging, to provide if not longer life, then better quality of life throughout the life course. While these advances in science and technology promise wonders (for those who will be able to afford them), there is already established science that demonstrates how we can all improve our life quality over our lifespan. This same science can, today, improve the life quality of our elders - starting these interventions at any age. It's building strength:a well understood, human practice. No technology is required to build and maintain strength; only to move against gravity. Repeatedly. Research has repeatedly shown that resistance training for elders can improve quality of life while mitigating if not eliminating age associated co-morbidities. And yet, for all its proven effective, cheap - even free - benefits for healthful longevity, many elders are simply too weak to take care of themselves. According to a 2019 report from AgeUk on the State of Elder health, 15% of those aged 65-69, rising to 1 in 3 citizens over 85 in the UK require care.Some of the well-documented challenges to strength building are that, unlike a pill or garment or augmentation, to achieve the benefits of strength, one has to do the work oneself, actively. That takes time, effort, as well as the knowledge, skills and practices to support it. Mustering the effort can be even harder to achieve when one is already feeling weak, recuperating from an injury, a hospital stay, or from loneliness of isolation.The research in this project is specifically designed to address the challenges that keep elders from actively engaging in strength work. Our approach is to co-create interactions to help build the knowledge skills and opportunities to practice to build and preserve the strength needed to maintain healthful independence at home. Our approach is simple: design interactive technology and gestures to leverage what we - including elders - do every day that is already strength work: stand, sit, grip, pull, push, reach, balance - and translate these into activities for building strength. We call it this novel protocol "do it twice." Stand from sitting? That's strength. Do it twice. That's strength building - and that supports the knowledge skills and practice of "elder athletes" building capabilities rather than requiring assistance.Our approach is interdisciplinary: experts in Human Computer Interaction, Sensors and Physiotherapy, developing novel, affordable interactive technologies to make strength practice accessible effective and enjoyable with support to guide these activities, reflect progress, and share with friends. We call the approach "incidental interaction for everyday strength."So far, we have tested the approach for feasibility. In this small project, with our partners in sustainable, assisted living housing, NHS Trusts, professional therapy and coaching, and with participating elders as co-designers, we will be refining the interaction, the sensors and the exercise protocols. We will be able to tune our work at each stage to ensure best engagement. In three phases from design, to testing, to in-home evaluations we will together be validating the accessibility and efficacy of our approach.By realizing with this project the potential our preliminary work indicates and that our partners anticipate, we will contribute a new affordable breakthrough approach to help transform elder health and care, to enable longer, stronger elder independence@home.

e8875589-cdeb-4504-8e6c-2c5922e46645 ADOPTED PROJECT: Breast Cancer Choices: Evaluation and implementation of a digital patient-centred decision aid to support genetic testing in mainstream care. ADOPTED PROJECT: Breast Cancer Choices: Evaluation and implementation of a digital patient-centred decision aid to support genetic testing in mainstream care. Principal Investigator: Dr Katherine Morton, Senior Research Fellow Team: Dr Gillian Crawford, Consultant Genetic Counsellor, University Hospital Southampton NHS Foundation Trust, Dr Lucy Side, Consultant and Lead Clinician in Clinical Genetics, University Hospital Southampton NHS Foundation Trust, Dr Jackie Chandler, Evaluation Programme Manager (Qualitative), Wessex Academic Health Science Network, Dr Kate Lippiett, Senior Research Fellow, Wessex Cancer Alliance, Prof Diana Eccles, Dean of Medicine, Professor of Cancer Genetics, Faculty of Medicine, University Hospital Southampton, Prof Claire Foster, Professor of Psychosocial Oncology, University of Southampton, Mrs Lesley Turner, Patient and Public Involvement contributor, Ms Kelly Kohut, Consultant Genetic Counsellor, St George’s University Hospitals NHS Foundation Trust Start date: 1 May 2022 End date: 1 May 2024 Background The demand for genetic testing for inherited cancer susceptibility is rising and services are increasingly being provided in mainstream care. In Wessex last year, more than 180 genetic tests were offered to cancer patients in mainstream care, and this will increase in 2022 as more genetic services become mainstreamed and eligibility criteria are expanded. This means that genetic testing is offered by clinicians such as oncologists, surgeons and cancer nurse specialists rather than Clinical Genetic services. It is part of a move to routinely offer genetic testing to all cancer patients where there may be clinical benefit. The results of genetic testing can improve health outcomes by informing optimal treatment pathways and facilitating cancer prevention or early detection in family members. However, deciding whether to have genetic testing is a complex, personal decision with potentially life-changing implications for the patient and family. Many people with cancer are faced with this decision shortly after diagnosis, at an already stressful time. Without the support of specialist genetic counsellors to discuss the medical, psychological and social consequences of genetic testing, it is essential that these patients are given accessible and appropriate support as a complement to clinical conversations. Mainstream clinicians feel they lack the necessary skills and time to support patients in this complex decision process. Web-based decision aids could offer an effective solution, giving patients the flexibility to reflect on and discuss information about genetic testing in their own time, in light of their own personal values. Breast Cancer Choices is one such web-based decision aid which was developed through a two-year research project funded by Breast Cancer Now involving extensive patient input and a review of evidence. By evaluating the implementation of Breast Cancer Choices in mainstream services, we would not only provide improved support to breast cancer patients currently undergoing this difficult process, but also identify wider-reaching implications regarding how best to support patients with other cancers in the national move towards genetic testing. As 1 in 2 people in the UK are expected to develop cancer in their lifetime, with 5-10% of these cancers estimated to be due to inherited predisposition, a clear implementation strategy for mainstream genetic testing is essential. Overall, the project aims to evaluate the impact of Breast Cancer Choices on patient’s decision making and clinician experiences in mainstream care, and to understand how web-based decision aids can be effectively implemented across mainstream cancer care.

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

< Back Our journey in partnership Why Pat and Julia became involved in research Pat Walkington and Julia Burton have been working with researchers from across England as part of a National Priority Research Programme in Ageing, Dementia and Frailty . The programme is a collaboration between ARCs which has been working to improve care for people with dementia and prevent falls in older people. Pat and Julia were supported in their work with researchers by Vikki and Naomi from the University of Exeter as part of ARC South West Peninsula, The overall programme had been initially led by Professor Helen Roberts based in Southampton as part of the ARC Wessex. Five years later, Pat and Julia have reflected on their continuing work: Pat writes: I have been a member of the public and community involvement and engagement panel for the Applied Research Collaboration (ARC) for Greater Manchester for about 12 years and later also became a member of the Health Innovation Greater Manchester panel. I have worked on many different health research projects where I have been able to offer a public/patient perspective. This includes writing plain English summaries for funding bids, sitting on advisory panels, being involved in different workshops and focus groups in my community as well as advising on information leaflets for the public. In November 2020, I was asked to review funding bids for Healthy Ageing, Dementia and Frailty National Priority Areas. Normally my involvement would end here but then in 2022 when a public panel member for the ongoing projects retired, I was invited to join the Programme Management Group overseeing the 3 projects. I was welcomed by the team, helped to be brought quickly up to speed with progress so that I felt comfortable and valued as part of the team. The meetings were well-managed and, like Julia, I felt comfortable about asking questions, asking for clarification if there was something that I didn’t understand, and being able to give a patient/public perspective. I valued the support of Vikki Goodwin and Naomi Morley , the PPI lead members of staff, who offered to meet with Julia and me before and after the Programme Management Group meetings so that we could get to know each other, discuss progress, ask questions and share ideas. This was a positive experience which I have now asked to be introduced to similar work Greater Manchester. I had never heard of a Community of Practice so this was a new and interesting learning experience for me. Like Julia, I found this so valuable in being able to openly discuss project progress, ideas and issues with other PPI teams working on similar projects across the ARCs in different areas of the country. I was disappointed when funding for this ended and our work could not continue. However, now that I know that Communities of Practice can be so valuable I would not hesitate to encourage these to be set up for other research projects. Finally, I am also involved as a PPI member/research partner in one of the 3 projects, the Flexi (Falls Exercise Implementation) Study, in Greater Manchester. This has been another learning experience for me from writing the plain English summary and working on the funding bid, being an equal partner, to now being involved in PPI workshops with members of the public who have taken part in the exercise classes. This morning we were listening to their ideas for public leaflets for the project extension and the positive experiences of how much stronger, fitter and confident that they felt from doing the exercises. They also said how much they had enjoyed the social aspects of exercising together. Pat Walkington public contributor I feel that as a PPI member I have made a difference and I have been able to give something back to the society and health service that has supported me. Julia: I have been involved as a patient/public contributor since the very start and, supported by Vikki Goodwin and Naomi Morley (Exeter), have been enabled to contribute at every stage. I attended all the very regular management team meetings where it was very clear that Helen Roberts valued our input and ensured that the meetings were run in a way that made the content accessible to non-academics like me. Julia Burton public contributor I do have some years of public patient involvement and co-production in research, initially volunteering with the Alzheimer’s Society with lived experience of my mother’s dementia, but terminology, acronyms and on occasions, scientific content can need explanation. It was very interesting to be involved in the programme of three research projects that are aimed at providing interventions for my age group. In my opinion, a very valuable and positive experience was the Community of Practice where the three funded project leaders and PPI leads met outside of the Management Group. Set up by the Management Group and facilitated by Naomi Morley we had regular meetings where issues involved in the progression of the research were discussed together and information, support, contacts and ideas shared. This community became more useful as time went on and resulted in cooperation and problem solving across the ARC s as the three projects were addressing the same NIHR priority. I was disappointed when the funding for this was not extended although Pat Walkington and myself are still involved in the management group. PPI contribution can be seen as a respected part of the entire programme. This was highlighted when Naomi, Pat and I spoke about patient and public involvement across the programme and development of a community of practice at the British Geriatrics Society Autumn Conference in November 2023. We were the only public contributors at the conference and I hope we were pioneers to be followed by others in the future. Previous Next

e57a4343-00e9-4e08-9056-d084e47c8870 Reframing responsibility through public empowerment: examining environmental cues influencing poor diet Team Dr Nestor Serrano-Fuentes. Senior Research Fellow. School of Health Sciences, University of Southampton. Dr Lyn Ellett. Associate Professor of Clinical Psychology. School of Psychology. University of Southampton. Prof Mari Carmen Portillo. Professor of Long-Term Conditions. School of Health Sciences University of Southampton. Prof Janis Baird. Professor of Public Health and Epidemiology, MRC Lifecourse Epidemiology Centre, University of Southampton. Prof Christina Vogel. Deputy Director, Centre for Food Policy City, University of London. Rachael Eckford, Occupational Therapist Partners Dr Lindsay Welch. Clinical associate professor at the University of Bournemouth. Previous Program Lead Health Inequalities (Health Innovation Wessex) Start: 27th February 2023 End: 30th September 2024 What's the issue? The United Kingdom (UK) consumes the most ultra-processed diet of any country studied in Europe. This scenario indicates that poor diets have become normalised in this country. Consequently, there has been a dramatic increase in diet-related conditions, such as obesity, type 2 diabetes, cardiovascular disease or several types of cancer and the financial costs attached to them. The UK food system is a complex setting for individuals to navigate. Individuals choose which foods to purchase and eat based on many determining factors (both internal and external). Our food environment has changed in the last 50 years and the term ‘obesogenic environment’ is now used to describe some of our food environments. Obesogenic environment meaning a setting which encourages weight gain and discourages weight loss by making unhealthy foods readily available. The environment we live in is a large factor for determining our food choices and poor-quality diets cluster in disadvantaged groups, for example those with low levels of education, low incomes or living in deprived areas. Responsibility for our food choices is culturally framed on the individual What did we find? I n the ARC Wessex project ‘ Reframing responsibility through public empowerment: examining environmental cues influencing poor diets ’ we completed a review of thirty-six articles. Studies exploring public perceptions of poor diets acknowledged personal and broader systems drivers, with individual responsibility predominating across studies. Research analysing media portrayals showed similar patterns of individual responsibility among right-leaning newspapers, which focused on individual lifestyle changes. However, left-wing newspapers highlighted the role of the food industry and the government. Studies analysing government policies identified citizens as the primary agents of change through rational decision-making. Policies and media portrayals provided limited emphasis on these populations, with individual responsibility narratives prevailing. Following this review, we undertook a qualitative study with 15 individuals with obesity/overweight exploring their perceptions of responsibility for poor food diets, with particular attention to how individuals understood and positioned personal and environmental influences on food practices. Our findings highlighted that despite food choice being complex and having many external and internal factors, the public perception has been framed to hold the individual accountable for their food choices. There is consensus that lifestyle factors alone will not fix the problem of obesity and therefore individuals being ultimately responsible for their diets is not the solution. NIHR ARC Wessex supported this project, enhancing opportunities for dissemination, implementation and networking with key local authorities and organisations. We expect our findings to raise awareness of good food choices and the development of tools that could support community care of people with obesity or at high risk of obesity. Further policy work is needed to address the root causes of diet-related health inequalities to implement mandatory regulatory frameworks that set standards for commercial practices. Developing tools to raise awareness of poor diet choices and increase informed decisions Research papers and books Serrano-Fuentes N, Rogers A, Portillo MC. Beyond individual responsibility: Exploring lay understandings of the contribution of environments on personal trajectories of obesity. PLoS One. 2024 May 8;19(5):e0302927. doi: 10.1371/journal.pone.0302927. Serrano-Fuentes N, Ellett L, Vogel C, Baird J, Tavares N, Portillo MC. Mapping how responsibility for poor diets is framed in the United Kingdom: a scoping review. Public Health Nutrition. 2025;28(1):e167. doi:10.1017/S1368980025101079

f5788d42-1d65-4ac1-a9d5-00a8fcb316fd Improving support for self-management (WASP) Using the Wessex Activation and Self-Management and Personalisation (WASP) Tool to design and implement system wide improvements in self-management support for people with long-term conditions See the WASP website https://www.wasp.soton.ac.uk/ Principal Investigator: Professor Mari-Carmen Portillo Team members: Professor Mari-Carmen Portillo (Professor of Long-Term Conditions, School of Health Sciences, University of Southampton), Dr Hayden Kirk (Consultant Physiotherapist & Clinical Director Adults Southampton, Solent NHS Trust), Dr Chris Allen (Lecturer, School of Health Sciences, University of Southampton), Stephanie Heath (WASP Clinical Lead, Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust), Dr David Culliford (Senior Medical Statistician, School of Health Sciences, University of Southampton), Dr Louise Johnson (WASP Project Manager, Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust), Dr David Kryl (Director, Centre for Implementation Science, University of Southampton), Professor Alison Richardson (Professor of Cancer Nursing and End of Life Care, University of Southampton) Start: 1 October 2019 Ends: 30 September 2024 Project Partners: Solent NHS Trust, Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust, Hampshire and Isle of Wight ICS Summary Good health and health care are key to a flourishing society. Focussing on what matters most to patients is essential for accessible, equitable and efficient care. In an NHS that is facing many challenges - including an increasing prevalence of multimorbidity and high levels of workforce burnout - this is easier said than done. The Wessex Academy for Skills in Personalised Care (WASP) has developed a programme to facilitate adoption of personalised care in practice. Led by the University of Southampton in partnership with NHS organisations across the Southeast, this programme supports health and social care services to embed personalised care practices – through rigorous evaluation, training, and bespoke improvement initiatives. Research is underway to evaluate the impact of the programme, and to understand how it could be spread and scaled. If adopted nationally, this programme has potential to be the catalyst for changing how we deliver and sustain services across the NHS. Impact People with multiple long-term conditions (MLTC) represent a significant proportion of the primary care population; with an estimated 14 million in England living with two or more chronic conditions. Many experience high treatment burden, fragmented care and reduced quality of life. While national policy promotes personalised care, implementation at scale has proved challenging. Services often lack the tools, skills and system support needed to embed personalised approaches into everyday practice. Difficulties in defining and measuring personalised care, add further challenge. The Wessex Academy for Skills in Personalised Care (WASP) was established to address this gap. Funded and commissioned by Hampshire and Isle of Wight and Dorset Integrated Care Boards (>£710K), WASP has developed an evaluation and training approach, focused on cultural and system-level change rather than isolated interventions. Led by the University of Southampton and working in close partnership with NHS organisations, WASP supports health and social care services to embed personalised care in a sustainable way. Training is accredited by the Personalised Care Institute and WASP is a partner with the Coalition for Personalised Care. Being hosted within NIHR ARC Wessex has enabled WASP to bring together research expertise, service improvement skills and frontline clinical experience. This collaboration underpins a structured programme built around three core elements: evaluating current practice, building skills through accredited training, and supporting services to make sustained improvements. A co-produced service evaluation tool enables teams to reflect on how personalised care is experienced by staff, service users and the wider system; enabling understanding of not just what happens in practice, but why. Training builds staff confidence and capability, while improvement support helps translate learning into measurable change. This work has had broad impact. To date, 45 clinical services across Hampshire, the Isle of Wight, Dorset and Sussex have completed the WASP programme. Over 1,400 healthcare staff have taken part in training, and more than 2,000 people, including clinicians, managers, commissioners and service users, have engaged with the service evaluation. Teams report shifts in mindset, with greater focus on “what matters” to individuals and increased confidence in delivering flexible, responsive care. People using services benefit from care that better reflects their priorities and circumstances, while staff gain shared language, clearer frameworks and practical tools. Commissioners and system leaders benefit from robust evidence to guide investment and improvement. WASP has also influenced practice beyond participating services, contributing to NHS England South East guidance; providing regional leadership on Patient Activation Measure use for NHS England; and contributing to ICB values-based care steering boards. NIHR ARC Wessex has been critical in enabling this impact by supporting programme development, evaluation and dissemination. ARC infrastructure has provided methodological and statistical expertise, mentorship, impact capture guidance and communications support, enhancing credibility and enabling scale-up. Through ARC Wessex, WASP accessed expertise across the University of Southampton, including business intelligence and the Business School, securing two development grants in 2023: the Southampton Enterprise Development Fund (£8,550) and Higher Education Innovation Fund (£10,000). Engagement has also taken place through WASP conferences in 2023 and 2024, with over 100 delegates including clinicians, commissioners and national policy stakeholders. The team is now collaborating with colleagues from UCL, Bristol, Leeds and Exeter to develop a programme grant focused on a scalable and sustainable personalised care intervention. This partnership demonstrates how NIHR investment can translate evidence into meaningful improvements for people living with long-term conditions. “It was good that we were able to focus on how shared decision making can work for continuing healthcare joint working on assessing challenges and positives- in a structured way. The idea of the need was there, and it helped to provide the framework to address the need ” [Programme Participant] https://www.wasp.soton.ac.uk/ We have now held 3 regional conferences, with attendance from 100+ delegates and a range of regional and national speakers – photos can be found on the conference page of our website. https://www.linkedin.com/company/wessex-academy-for-skills-in-personalised-care A scoping review followed this project to provide the rationale for the WASP assessment tool of personalised care practices – this has now been published: Johnson et al (2025) Next? WASP II is now evaluating and collecting evidence of the impact of the Wessex Academy for Personalised Care programme. We are conducting a secondary data analysis on existing WASP survey data, to better understand the behavioral factors impacting personalised care practices. We are seeking for further NHS teams to complete the training beyond Wessex. We are planning an NIHR PGfAR Submission in April 2026 – focussing on sustainable and scalable development and national evaluation of the programme. We are collaborating with UCL, Bristol, Leeds and Exeter, as well as the Personalised Care Institute. Now there's a series of FREE webinars to develop skills supporting personalised care, for health and care professionals in the Isle of Wight, Hampshire. More here

db1daab2-c480-4960-beba-7955afeebc20 Wessex Frail2Fit – A feasibility and acceptability study of a virtual multi-modal intervention delivered by volunteers to improve functional outcomes of older adults with COVID-19 discharged from hospital Lay project title: Can we train volunteers to deliver exercise and nutrition support to older adults with frailty after a hospital stay? Project Partners: University of Southampton; University Hospital Southampton NHS Foundation Trust; Bournemouth University; Swansea University Principal Investigator: Dr Stephen Lim Team members: Dr Stephen Lim ( NIHR Clinical Lecturer in Geriatric Medicine, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton), Dr Samantha Meredith ( Research Fellow, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton ), Professor Mike Grocott ( Professor of Anaesthesia & Critical Care, Clinical and Experimental Science, University of Southampton), Professor Sandy Jack (Consultant Clinical Scientist in Anaesthesia and Critical Care, University Hospital Southampton NHS FT), Professor Jane Murphy (Professor of Nutrition, Ageing and Dementia Research Centre, Bournemouth University), Dr Judit Varkonyi-Sepp (Chartered Psychologist, Manager Behavioural Science Theme, NIHR Biomedical Research Centre, University of Southampton), Andrew Bates (Clinical Academic Intensive Care Nurse and Critical Care, Clinical and Experimental Science, University of Southampton), Luisa Holt (Physiotherapist, Research Fellow, University of Southampton), Professor Kelly Mackintosh (Professor in Sport and Exercise Sciences, Swansea University), Professor Melitta McNarry (Professor in Sport and Exercise Sciences, Swansea University), Cynthia Russell (patient representative), Steph Keith (Volunteer services - Patient Support Hub Coordinator), Kieran Fifield (Volunteer services - Project Support Officer) Start: 31/10/2022 Ended: 10/01/2024 Lay Summary Around half of older people over the age of 65 in hospital are affected by frailty. Frailty is a long-term health condition where your body loses its natural reserves. People with frailty take longer to bounce back from simple things, like a common cold, they tire easily, and need a bit more help to do things. Exercise and good nutrition are important to build strength in older people with frailty and can help them to perform their normal daily activities, like dressing, or cooking a meal. However, the motivation to eat well and to move more after a hospital stay can be hard for many older adults living with frailty. We found that we could train volunteers to encourage older people with frailty to eat well and exercise after a hospital stay. Hospital volunteers were trained by a health professional to deliver 3-month support to older people online through Zoom, or over the telephone. Five hospital volunteers completed the training. The volunteers were college students (3 female) with an average age of 16 years and were interested in gaining experiences working in a health setting. The exercises were seated strength movements using resistance bands. Volunteers were also taught to use the ‘nutrition wheel’ which is a tool to help start conversations with older people about their eating and whether they had lost any weight. Older people who were identified as at risk of undernutrition (not getting enough nutrients to support their health) were given booklets containing suitable nutrition advice. Twenty-seven older people with frailty signed up to receive support from the volunteers, and seventeen completed the 3-month programme. Eight older people completed the intervention online, and 9 opted for telephone support. The volunteers delivered 45 online sessions and 90 telephone calls from January 2023 to October 2023. After the programme we found that older peoples’ physical activity levels, quality of life, and appetite improved, and they maintained these improvements at 3-month follow-up. Only 1 minor incident happened during exercise where an older person strained their shoulder muscle using the resistance band. We interviewed volunteers, older adults, and their carers to find out more about what they thought of the exercise and nutrition support. Participants completing the online sessions enjoyed the group interactions and described the sessions like ‘a virtual cuddle’. They appreciated the support of the younger volunteers, who helped motivate and guide their exercise and nutrition behaviours. Participants receiving support through weekly telephone calls felt the volunteers were very encouraging and provided non-judgmental support. Overall, participants thought the online sessions helped build a better exercise routine, but the one-to-one telephone calls allowed more in-depth, personal conversations around nutrition. The young volunteers found listening to some of the illness stories of older people leaving hospital quite emotionally difficult. But they found the experience changed their perceptions on ageing. The volunteers had support from the trainer to help with any challenging conversations. Some older people found a key barrier to participating in the programme was their unmet care needs. Older people with better social care had resources to focus on their health, whereas older people who were alone and unsupported were more focussed on meeting their basic care needs rather than participating in the support programme. Overall, it was safe and feasible for volunteers to deliver exercise and nutrition support to older people living with frailty after a hospital stay. What we did with the new knowledge Our findings are helping to develop a volunteer toolkit, including recruitment packages, and training and support materials for future volunteer-led projects in hospital and in the community. Where next? We are working with various Universities and community organisations to develop a volunteer-led intervention to improve health and wellbeing of older people in different regions and for older people from diverse ethnic backgrounds. What did people say about the work? Volunteer: “It (training) was very thorough, and I knew what I had to do when I first started. Especially at the beginning, when I was invited to join one of the zoom sessions, to see the volunteer delivering the exercises. And also, the nutrition support; that was really helpful to understand how everything worked. Not only how it was meant to, but how someone delivered it. I thought the training was amazing, and I felt comfortable with what I was doing when I first started.” Participant receiving telephone support: “ What was very good was they (volunteers) didn’t push it too much. When I said I exercise 3 times a week, they didn’t push that and say, ‘oh, you should be doing this; you should be doing that’ - they didn’t push anything… They just encouraged you, which was good…. They were polite, finding out what I’d been doing, and what I hadn’t been doing I s’pose but not criticising me for not doing it… They’re concerned about you, getting people back to normal, aint they?” Participant receiving online support: “ I enjoyed doing the one online. It was interesting talking to people to see what other people were feeling and how they were all doing…. You sort of get that feeling that you’re part of something… it was fun. Strangely enough, I would find myself looking forward to the next one…” Participant receiving online support: “ Full of enthusiasm.. They (volunteers) weren’t just telling you what to do, they were rooting for you too, ‘come on, we can do this!” Publications Frail2Fit study protocol: a feasibility and acceptability study of a virtual multimodal intervention delivered by volunteers to improve functional outcomes in older adults with frailty after discharge from hospital | BMJ Open

5a0c9214-8a00-419e-80b5-dd5d80c94fdf ADOPTED PROJECT: Magnet4Europe: Improving mental health and wellbeing in the health care workplace Joint Lead: Professor Peter Griffiths and Professor Jane Ball Partners: University of Southampton, Katholieke Universiteit Leuven (KUL), Belgium Start date – Jan 2020 End date – Dec 2023 Lay Summary The pervasiveness and growing levels with which mental health morbidity is reported by healthcare professionals is a matter of concern. Underlying causes are frequently rooted within the work environment. In the United States, implementing the Magnet© model of organizational work re-design for nurses in hospitals has been associated with improved mental health, reduced burnout and turnover and improved patient outcomes, yet the model has not been implemented at scale in Europe. The aim of the EU-funded Magnet4Europe study is to transfer, modify, scale up, and evaluate the Magnet© model in 60 European hospitals in 6 countries (Belgium, England, Germany, Ireland, Norway, Sweden) between 2020 and 2023. The intervention involves the following: implementing hospital-wide change via a bundle of organizational measures as stipulated in the Magnet© manual, facilitated by one-to-one twinning with 60 Magnet© recognized U.S. hospitals with experience in implementing the Magnet© model, a European learning collaborative for hospital managers, and a critical mass of hospitals promoting innovation to attract public interest and foster replication. Magnet4Europe uses a usual-practice wait-list cluster randomized trial (RCT) to determine the effect and costs of Magnet© hospital organizational redesign on nurse and physician health outcomes and wellbeing, with burnout as the primary outcome, using validated instruments. Secondary outcome variables include staff well-being and turnover. In addition, the implementation of the intervention is evaluated using a nested mixed-methods process evaluation, based on focus groups and individual interviews with a selection of hospitals in the participating countries. Analyses will be based on quantitative (RCT) and qualitative methods (process evaluation) and a triangulation of the findings. Dissemination of the results are planned for different audiences, including clinicians, hospital managers, policymakers and the wider public. NB: The term ‘Physician’ is used for consistency across the EU countries in the study Consortium. In the UK context the staff group referred to equates to Medical Staff -Medics Intervention Hospital Magnet® is a trademark of ANCC registered in the United States of America and other jurisdictions and is being used under license from ANCC. All rights are reserved by ANCC. ANCC’s consent to the use of the Intervention Hospital Magnet® mark shall not be construed as ANCC sponsoring, participating, or endorsing the Magnet4Europe intervention. ©American Nurses Credentialing Center. Reproduced under license from the American Nurses Credentialing Center. All rights reserved. Publications Laying the foundations for implementing Magnet principles in hospitals in Europe: A qualitative analysis - ScienceDirect

402a4c2a-6e60-4ba0-ab22-b08ca49f80a9 Deprescribing and Optimisation of Medicines IN Older people with Heart Failure and Frailty (DOMINO-HFF) Chief Investigator: Dr Eloise Radcliffe, Senior Research Fellow School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton Team: Dr Kinda Ibrahim, Associate Professor, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton Dr Sara Mckelvie, Clinical lecturer, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton. Dr Stephen Lim, Principal Clinical Research Fellow, Consultant Geriatrician, Medicine for Older People, University Hospital Southampton, Southampton General Hospital. Dr Chris Young, Consultant Geriatrician, Medicine for Older People, University Hospital Southampton, Southampton General Hospital. Dr Nina Fudge, Lecturer, Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London. Dr James Sheppard, Associate Professor, Nuffield Dept of Primary Care Health Sciences, Medical Sciences Division, University of Oxford. Mrs Clare Howard, Clinical Lead for Medicines Optimisation, Health Innovation Wessex. Prof Simon Fraser, Professor of Public Health, School of Primary Care, Population Sciences and Medical Education,Faculty of Medicine, University of Southampton. Dr Peter Cowburn, Consultant Cardiologist, University Hospital Southampton, Southampton, General Hospital. Ms Rajneesh Kaur, Patient and carer representative . Partners: University Hospital Southampton NHS Foundation Trust, University of Southampton, Health Innovation Wessex, Queen Mary University of London, University of Oxford. Start: 1 October 2024 End: 31 March 2026 Background Heart failure (HF) is a long-term disease with symptoms including breathlessness, tiredness and leg swelling. HF is more likely to affect older people and is the leading cause for hospital admission in the UK for those aged over 65 years. Most people with HF have other health conditions therefore taking multiple medication is common. Guidelines for doctors to treat HF recommending multiple medications to help improve symptoms and help people live longer, have led to concerns about further increases in numbers of medication for patients. The application of these guidelines in older adults has had the unintended problem of more complex medication regimes, and possible impacts on physical ability and quality of life. More generally, taking multiple medication can increase risk of side-effects, hospital admission and death for older people. The research studies used to decide guidelines for doctors to treat HF, may underestimate the risks of taking multiple medicines as they do not include populations most vulnerable to potential harms such as older adults and those with frailty. This leads to uncertainty about the long-term benefits and risks of HF medications in the very old and frail populations who are, nonetheless, still treated based on the guidelines. Prescribing should ideally be tailored to each patient’s health condition and their preferences. These factors will change over time, supporting the need for regular medication reviews, and where appropriate, the need for reducing, stopping, or switching drugs in order to improve outcomes. However, this may be challenging due to the lack of research studies, as patients and multiple health care professionals involved in caring for older patients with HF, may experience uncertainty and have differing approaches to the application of the guidelines. Aim To examine research studies on prescribing and deprescribing of HF medication in older people, including those living with frailty. This will inform current guidelines for doctors to treat HF. It will also identify gaps in the research on this vulnerable group commonly prescribed HF medication, but at the greatest risk of experiencing harms linked with taking multiple medications. Design and methods Two literature searches will be carried out, guided by an information specialist librarian, following the established guidelines. Patient, public and community involvement This study has patient and public involvement (PPI) throughout. We will have PPI group of older people and carers living with HF, chaired by our PPI lead who is also a research team member and has contributed to study development. The group will contribute to the interpretation andcommunication of findings on a wider scale. What did we find out? •We found that there is very little research on prescribing for older people with heart failure, especially those aged over 75. No studies looked at frailty, which is important for understanding how well treatments work in this group. Very few studies reported on ethnicity, and none considered people’s socio-economic background. Only a small number included information about quality of life, and none were carried out in primary care settings. •Overall, this means there is not enough good evidence to clearly understand the benefits of heart failure treatments for older people. •Some medications may help, particularly a group called SGLT-2 inhibitors (also known as “gliflozins,” such as dapagliflozin), but it is difficult to say how much benefit they provide. In addition, side effects may make these treatments harder to tolerate and could increase the risk of harm for some patients. •We found that for research on stopping or reducing (deprescribing) heart failure medications for older people is also limited. Stopping medicines during a sudden worsening of symptoms may be harmful. However, the available evidence is limited and varies in quality, and it does not properly consider people living with frailty. This highlights an important gap in research and a need for better evidence to guide safe treatment decisions. What have we done with this new knowledge? We have presented findings at the South West Society for Academic Primary Care conference in Oxford, and later in the year at the European Geriatric Medicine Society in France, and are publishing the results of the two systematic reviews in two peer-review widely read journals. We also plan to share the findings with We will share findings with the National Clinical Director for Prescribing in England, Prof. Tony Avery, and the British Geriatric Society (BGS) and present the findings to the South West BGS group. This will ensure the findings reach decision-makers who design and fund future clinical trials. The impact of this research is in contributing to the evidence base and identifying critical gaps in knowledge about how heart failure medications are used in frail older populations. It highlights the underrepresentation of these groups in clinical trials and the limited evidence available to guide deprescribing. This will inform priorities for future research, while also supporting greater awareness among clinicians of the need for personalised, context-specific prescribing and shared decision-making. In the long-term this will contribute to safer prescribing, reduced medication-related harm, improved quality of life, and fewer avoidable hospital admissions. What will we do next? •This is a complex and challenging area of research. Our work has highlighted variation in approaches to prescribing, as well as differences in the challenges faced by healthcare professionals across disciplines and care settings. •It is clear that further high-quality clinical trials are needed to address the important gaps we have identified—particularly the lack of robust evidence on prescribing and deprescribing for older people with heart failure who are living with frailty and multiple long-term conditions. •We will share findings with the National Clinical Director for Prescribing in England, Prof. Tony Avery, and the British Geriatric Society (BGS) and present the findings to the South West BGS group. •We hope our findings will contribute to the recent ongoing public debate on medicines optimisation in frail older people, and will shape and inform future research, supporting the development of clearer, more relevant evidence to guide care for this population.

1f1252b1-cfe9-4800-b5dd-f3b53069d91a Understanding psychosocial determinants of alcohol use disorder (AUD) in older adults: exploring the role of social networks and loneliness in living with AUD (OLA study 2). Project partners (charities, Universities, NHS trusts, care providers etc): University of Southampton, University Hospital Southampton NHS Foundation Trust Full team listing including PPI Professor Julia Sinclair – Chief Investigator Professor Jackie Bridges – Co-applicant Dr Becky Band – Co-applicant 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 Summary Alcohol use disorders (AUD) in older adults is a growing problem which is currently under-recognised and under-treated. With little research into this area, there is no in-depth understanding about the factors that may contribute to AUD in older adults, nor the lived experiences of this group. Some have suggested that factors such as social isolation, loneliness and loss associated with older age may be important in understanding alcohol use. We know that in general, limited social contact and loneliness have a negative impact on both mental and physical health. One way to understand the amount and types of social connections someone has is to map their personal social network. This might include a whole range of people such as important family, friends, neighbours and acquaintances, pets, community places, groups or activities. This helps people to think about who is important in their daily lives, the roles that different relationships play, how this might have changed over time and how this might be improved, for example, by exploring ways to obtain additional support in the future. In this study we will invite older adults who have participated in a linked study to take part in an interview. The linked study will follow-up older adults with AUD for 6 months after being admitted into hospital. The people invited to this study will be selected based on lots of different factors, such as their age, how many people they live with, or how lonely they are, to ensure we are able to capture a variety of experiences within this group. Only those who have given permission to be contacted will be approached. The interviews will be 1:1 with a researcher and might happen in person, over the phone or through an online video call. Participants will first be guided through the process of mapping their current social network with the researcher. The interview will then discuss the support received from the person’s social network, as well as talking about the participants’ daily lives (including daily routines, physical and mental wellbeing and valued activities) and additional support needs. Interviews will last around 1 hour. They will be audio-recorded, transcribed and anonymised before analysis. 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 did we do with this? 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. What's next? We have formed a stakeholder group to discuss our findings and what the most appropriate next steps should be. 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.

de23ed25-467a-496e-b29a-68a949839608 ADOPTED: FLOWS Planning for Frailty: Optimal Health and Social Care Workforce Organisation Using Demand-led Simulation Modelling Principal Investigator: Dr Bronagh Walsh, Associate Professor, School of Health Sciences, University of Southampton. Team: Professor Peter Griffiths , School of Health Sciences, University of Southampton: Dr Carole Fogg, School of Health Sciences, University of Southampton: Mr Mike Hepburn, Southampton Business School, University of Southampton: Dr Abigail Barkham, Southern Health NHS Foundation Trust: Honorary Professor Martin Vernon, Tameside and Glossop Integrated Care NHS Foundation Trust: Professor Lee-Ann Fenge, Department of Social Work and Social Sciences, Bournemouth University: Professor Jane Ball, School of Health Sciences, University of Southampton: Professor Sally Brailsford, Southampton Business School, University of Southampton: Ms Francesca Lambert, PPI lead, School of Health Sciences, University of Southampton. Start: 01/11/2022 End: 31/10/2025 Background: As the population ages, robust workforce planning to meet future demands for health and social care by older people is needed. A lack of evidence in this area has led to a mis-match between the health and social care demand from the ageing population and the current workforce capacity. The proposed study will use demand-led simulation modelling of the workforce required to address the specific challenge of providing health and social care for the growing numbers of older people living with frailty. Aims & Objectives: The aim of the study is to use simulation modelling to explore long-term trends in frailty-related health and social care use in the ageing population and its implications for future workforce size and competencies to support high quality care. The primary objective of this study is the creation of a simulation model that will inform service and workforce planning to meet health and social care needs associated with frailty. Methods: The study will use a System Dynamics design to develop and test the simulation model. Work packages comprise a scoping review, gathering of public and professional perspectives on service provision via a survey and stakeholder engagement activities, and analysis of linked health and social care data, all of which inform the simulation modelling work package and development of a workforce planning toolkit. Timelines for delivery: The scoping review will be completed in year 1. Routine health and social care data specification and extraction will occur in year 1, as will service mapping and classification and survey preparation. Survey data collection and analysis will occur in year 2. Simulation modelling will commence in year 2, with validation, sensitivity analyses and scenario modelling in year 3. Development of workforce guidelines and toolkit will occur in. year 3 Stakeholder engagement, including patient public involvement, will run throughout the study, reviewing study results and informing development of the other work packages. Anticipated impact & dissemination: This study will provide new, direct evidence about the impact of frailty on health and social care workforce requirements within the ageing population The improved understanding of workforce requirements offered by this study will inform workforce planning for frailty services across health and social care, ensuring future benefit for patients through provision of timely and appropriate care and a workforce planning toolkit to support local decision-making.