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1c23cf8b-3886-4a98-9ca5-1588bcdda392 ADOPTED PROJECT: Development of a decision aid for offloading device selection for people with diabetic foot ulceration ADOPTED PROJECT: Development of a decision aid for offloading device selection for people with diabetic foot ulceration Principal Investigator: Dr Lindsey Cherry , Associate Professor University of Southampton Research team: Dr Emma Cowley, University of Southampton; Dr Michael Backhouse, Associate Professor, University of Warwick; Dr Kate Lippiet, University of Southampton & Wessex Cancer Alliance Partners: University of Southampton & Solent NHS Trust, University of Warwick & Wessex Cancer Alliance Lay Summary: We aim to create a visual tool, called a decision aid (DA). A DA shows the good and bad points for different treatment options. A DA can help people choose the best treatment for them. Helping people choose their treatment can make them healthier and happier in the longer term. We also aim to find out what is needed to support clinicians to use the DA.Treatments to help diabetic foot ulcers (DFUs) heal include a plaster cast or removeable boot. Both treatments have good and bad points. For example, we know casts tend to heal DFUs faster than boots, but you cannot drive with them. People can drive with a boot. Driving may be a priority for some people, to collect children or get to work, but healing quickly could be a priority for others. Aim: To develop a shared decision aid (DA) for offloading device selection for people with diabetic foot ulceration; A secondary aim is to explore workforce willingness, confidence, and competence to use DAs and shared decision-making. Methods: Two parallel workstreams (WS) will be completed. WS1 DA development will be undertaken in accordance with the International Patient Decision Aid Standards. The DA will likely contain information about a) the decision to be made, b) option risks and benefits, c) related values and d) decision next steps. WS2 Workforce readiness will be evaluated through a) scoping literature review, b) national workforce survey, and c) stakeholder focus group about workforce capability development, training needs, and implementation recommendations. Expected outcomes: WS1 will produce a decision aid and the consolidation and generation of new partnerships ready for full trial evaluation. WS2 will identify priority areas to support workforce implementation of shared decision-making and DAs. This programme addresses multiple JLA priorities including PSP1, PSP2, PSP5 and PSP9. Additional benefits include research capacity growth in PSP areas through subsequent national multi-centre trial, with routes to support Advanced Clinical Practice and an embedded PhD studentship.

Project Outputs Project Outputs This domain helps you consider the deliverables or what is to be produced as a result of your project. These are the project outputs . Outputs can be singular or multiple and include any of the following: policy guideline(s), innovation, intervention, website or a tool. Adoption and Spread Project Outputs Buy-in and Engagement Fit with Health and Social Care Systems Alignment with Health and Social Care Priorities Outcomes and Impact Project Outputs Buy-in and Engagement Fit with Health and Social Care Systems Alignment with Health and Social Care Priorities Outcomes and Impact Adoption and Spread Checklist, webinar and resources Quick links: Case study “ As we had early discussions t o identify our project outputs within our team, we were able to plan resources required to support this. For example, we knew that one of our key outputs would be a website to be made freely available to all. However, as we engaged with our wider networks of stake holders across d ifferent care homes, we realised that some also expressed interest in having a printed training resource which they could share with colleagues when hosting in-person workshops . This presented a challenge initially as we had not costed for the development of these printed materials. However, as we were still at an early stage of the project, we were able to apply for a small grant which helped accommodate these costs. Stakeholder involvement was invaluable to ensuring that our project outputs matched their needs . We will take this learning forward in future projects and consult with a range of stakeholders initially. This will help to support our project outputs to be available and accessible in formats which best fit the needs of those using them.” Person-centred care training resource for care homes project (PCCP) Take away tips Early engagement with stakeholders about what project outputs are helpful for them can enhance their longer-term value and utility Early engagement also ensures that resources can be prioritised and financially supported

Sandra Bartolomeu Pires is a Research Sister in Neurodegenerative diseases at University Hospital Southampton and PhD Candidate at the University of Southampton < Back Don't do it! Sandra Bartolomeu Pires Sandra Bartolomeu Pires is a Research Sister in Neurodegenerative diseases at University Hospital Southampton and PhD Candidate at the University of Southampton From 2018 to 2020 I cowboyed through fellowships and awards, trying to keep a percentage of my time academically focused, in pursuit of the Holy Grail – PhD funding. These varied from 9% to 50% with interim periods of zero (keeping the work going, though). “I just need some funding, my foot in, then I will make it work”. In September 2020, alleluia, PhD scholarship secured! I made a happy dance while holding my 3-year-old daughter and she laughed loudly without understanding why mummy was making such a fuss over a phone call (now that I think about it, she was probably just mocking my lack of dance skills…). I couldn’t believe it. Starting September I would be a PhD student at the University of Southampton! “So how does that work Sandra?”. Well, I get 50% of my time funded to do the PhD. I have funding for four years. “So you need to do a part-time PhD in four years, with a toddler, no family support... (*crickets chirping*) If someone can do it, that person is you!” “Do you have any advice before I start? Something you wished you knew from the beginning?” “Don’t do it”. I have heard this multiple times. Don’t do it; Why would you do it?; Have all your children first, let them go through school, and then do it. Oh please, what do you people know about this? Well, people that are now postdocs and know the pits of despair very well. I really appreciate their advice. They took the time to meet me, share their experience with me, and advise me when I asked for it. But then Seinfeld’s voice in my head “I am special, my mother was right” (yes, I say this joke too many times). “So you need to do a part-time PhD in four years, with a toddler, no family support... If someone can do it that person is you!”“Do you have any advice before I start? Something you wished you knew from the beginning?”“Don’t do it” Our lovely Jamie Stevenson, from the ARC Wessex communications team, challenged us to write how we (PhD scholars) feel in the beginning, and then see how the PhD relationship evolves through the years. The most prevalent thought is “I am not good enough.” – There are plenty of resources and podcasts on imposter syndrome, it’s a big thing, go look it up. My advice on this is something Hugh Kearns said: focus on facts, not feelings. One really needs to be able to balance those internal voices to juggle the daily pressures and workload. This year was more challenging than I could have predicted, worse than the people that had advised me imagined. And I still had it so much easier than many people. In the first COVID wave I paused my SHAPE award, which was so hard to get, to go back full-time clinically. How could I focus knowing all that was happening? So that meant preparing the ARC PhD funding application in my own time, while working full-time in COVID research. In the second wave I thought “Let’s make a tradition out of this!”, deciding to apply for a NIHR Clinical Doctoral Research Fellowship. A lot of my funded PhD time went into preparing this Everest application (while clinically I was once again moved to COVID research but this time inpatients). March was horrible. Deaths from young patients, deaths from colleagues, working clinically in an area out of my comfort zone, and this huge application, the cherry on top of the cake. I was broken and needed help. My supervisors were incredibly supportive, and the Staff helpline was my lifeline. Then, stomach pain. Daily, unable to eat properly without feeling uncomfortable (I LOVE FOOD!!). “That is stress!”. My reply was “I always had a stressful life and never had stomach pain”. Thinking back, it probably is “just” stress. I mean, I am not 20 anymore… After telling my husband “I have sent you an email with my login details, if I end up in the resus room (wouldn’t be the first time), please submit the application. Otherwise, I will come back to haunt you!” I actually managed to submit the application, at 2am. At 9am, all the kind souls that were my signatories and participatories, had signed (Thank you so much!) and off I went to Bournemouth beach with my mother and sister, who had travelled in the middle of a pandemic to see us, and whom I had barely laid eyes on. Freedom Day, 11th June (Sorry, Boris!). I could really have used some holidays then - or an induced coma for a week - but no can do. Diving back into my systematic literature review and thanking my past self for keeping good records. I am now past my first viva/First PhD review progression, straight out of the oven (23rd July 2021) and received overwhelming positive feedback “You seem to think you are delayed Sandra, but you are excelling at the PhD” (I hope the assessor and the supervisors didn’t notice my watery eyes). I write this as I am flying to Portugal to see my lovely family. My daughter and husband have been there for a week. So on the day of my viva I was actually alone all day. Not to worry though, plenty of wine in Portugal (Omeprazole and Rennie in the bag) and time to celebrate with those who support me most on this crazy journey. How was this first academic year? It was absolutely amazing! So (SO) hard, but thrilling, challenging, just the way I like it (I am sure it is some disease and I am just going undiagnosed all these years). The taste of victory is addictive: pressing that “Submit” button, reading my assessor’s report on PGR Tracker, having my long surname in papers (soon to come), the validation from my patient population, my supervisors proud of me, and the hope of making change happen for the best care of patients and carers. I am so excited for the next steps. Knowing that I pushed my boundaries, I am doing what I love, working towards a career that I dream of, surrounded by an incredible support network. For now, out of office “ON” on Hospital and Uni accounts. Breaks are important and I have earned my two weeks off. Let’s see what year 2 brings 😉 “I have sent you an email with my login details, if I end up in the resus room (wouldn’t be the first time), please submit the application. Otherwise, I will come back to haunt you!” Previous Next

ARC Wessex Early Career Researchers - Cara Black, Naomi Leonard, Olivia Taylor and Annabelle Prescott < Back Engaging Children and Young People in Research Community of Practice Inaugural Meeting ARC Wessex Early Career Researchers - Cara Black, Naomi Leonard, Olivia Taylor and Annabelle Prescott September 2023, University of York, UK There is a knowledge gap in our understanding about approaches and methods for meaningfully involving and engaging with children and young people in matters and decisions that impact on them. We went to a two-day meeting at the University of York with researchers from the University of York, Bristol, Hertfordshire, Southampton and Auckland, NZ as well as a representative from the International Alliance of Mental Health Research Funders. This group came together to form an international Community of Practice (CoP), with the goal of sharing learning, methods, and experience for effective ways to engage young people. It also highlighted the wide variety of opportunities for putting children and young people at the heart of research, decision making and advocacy for their mental health and well-being. Here are our reflections as early career researchers (ECRs) from the meeting: What did we gain from the meeting? We thoroughly enjoyed being with professionals who have expertise in research for youth health, wellbeing, mental health, and youth advocacy. We gained an understanding of what exactly a community of practice is, listened to the experiences of all members and contributed to the conversations. It was lovely to hear international voices and get to exchange creative ideas for involving young people and encouraging them to share their ideas, as well as learning a great deal about youth engagement in general. What were our highlights? Hearing from the Healthy Mind Apprentices; Chloe, Kenzie, Lauren & Phoebe who are a group of young people passionate about mental health who work across Bradford and Craven to support young people, communities and schools with their health and wellbeing. They reflected on their time working with Y-MHESH and spoke about what their apprenticeship meant to them and what they have learned along the way. They shared with us that the problem is not that young people don’t have a voice; they instead believe that decision makers are not listening. Therefore, it was interesting to hear that we need to take necessary steps to ensure ‘decision makers’ are able and willing to share the decision-making power with young people. Overall being involved in the CoP was positive, as we had the opportunity to be involved in discussions with leaders in the field. Often, we can become ‘stuck’ in our ideas, so having the opportunity to present new ideas and challenge our Community of Practice to think in novel ways which align with the realities for children and young people was a highlight for sure. What could have been improved? It might have been more beneficial for our CoP group if the Healthy Mind Apprentices joined us for longer, as these fabulous young people reminded us that it is about listening and valuing meaningful involvement of children and young people, so it would have been great to have more youth representation in our own decision-making processes. Youth voices should be included throughout our CoP meetings, whether this be the Healthy Mind apprentices or groups of different young people. One of the main challenges in this area is that when coproduction and research is done with young people, they often don’t see the outputs they have created or get to feel the impact of their work before they move. It’s important we consider this when setting out to do co-production work or research with children and young people. What are the advantages of involving early career researchers in research and in the CoP? We provide a fresh perspective on topical issues today and have greater freedom to think beyond our specialty areas. This gives us the ability to consider the broader picture at an international or societal level and bridge the gap between young people and established researchers, as we understand the points of view and needs of young people, while simultaneously understanding research processes. This meeting was a great way to solidify the learning from the CoP and focus us on a clear path forward to best support the goals of children and young people in research. Reflections Reflections on public engagement and engagement in research for young people From the perspective of an ECR, it seems extremely important that “brand image” and visibility are recognised by senior management at universities and funders at research centers. Engaging well with the public, in this case, young people, both heightens visibility and reinforces brand image, which is why Patient and Public Involvement and Engagement (PPIE) work with young people within schools, young people’s PPI groups and other youth groups, including the Healthy Mind Apprenticeship scheme, is so valuable. Although, it can be difficult to get PPIE work funded. The purpose of PPIE work is to get people’s views on what needs to be researched and what is important to them, so to do this after a project has been decided defeats the purpose. Young people form part of our communities, but their inputs have been historically overlooked as unimportant or uninformed. Yet, some of the most valuable insights come from our young people, because at the end of the day this is their reality, and they live it every day. It is therefore crucial to have young people be meaningfully engaged so research, funding and decisions are aligned with what people want and need – and children and young people should be no exception. If we consider and give power to the voices of young people, then perhaps we can work to meaningfully elevate the health and wellbeing of entire future communities. So with that, we leave you with this whakatauki (Māori proverb). Mā whero, mā pango ka oti ai te mahi With red and black the work will be complete Previous Next

8d1b2f3a-906f-4fe9-8d9a-bf4679c7d6ec COMPLETED: StOP UTI project: Strategies in older people's care settings to prevent infection Background Urinary tract infection is more common in older people living in care homes but can be difficult to recognise. This can lead to overuse of antibiotics and may result in antibiotic-resistant infection and hospital admission. We wanted to find out what can work in care homes to prevent and recognise UTI and what support care home staff need to enable safe care for all residents. What we did We reviewed evidence from a range of sources, including research studies and improvement projects. We also asked care home staff, residents, family carers and healthcare professionals about their experiences. We combined these experiences and ideas with the evidence we found from published literature to develop an understanding of what needs to happen in care homes for older people to prevent and recognise UTI. What we found out What difference will this make? UTI can be prevented by embedding prevention activities in care routines: ensuring residents are hydrated ensuring residents with recurrent UTI are managed actively with preventative treatment avoiding the use of urinary catheters wherever possible Unnecessary antibiotic use can be avoided by: involving the whole care team, resident and family in recognising UTI using active monitoring when there is uncertainty about UTI supporting care staff to develop the skills to accurately recognise UTI using tools that support decision-making and communication across the wider care team Safe care for each resident can be achieved when: care staff receive education that is contextualised to their role and helps them to prioritise and deliver person-centred care care home managers are committed to supporting the delivery of best practice commissioners and regulators promote UTI prevention and recognition as a priority area for care homes Why is this important? Our findings suggest ways that care home providers and policy makers can support the prevention and recognition of UTI in the care of older people living in care homes. A system-wide approach is vital to enable care home managers and their staff to prioritise UTI prevention and recognition as part of person-centred care. At policy level, there is a need to integrate UTI prevention with diagnostic and antimicrobial stewardship and to unify the content of education and decision-support resources so that care staff can see the value of their role in prevention as well as supporting diagnosis and treatment of UTI. What next? Our research is the start of a process of understanding what works in care home settings and will identify where further research is needed. A report, summary and articles provide practical examples and recommendations relevant to care home staff, care home managers, researchers, educators, carers and relatives for use to improve the prevention and recognition of UTI in older people’s long-term care and to plan further research to investigate them. We are turning our findings into a range of different resources and digital communications, with input from experts who support the adoption and spread of innovation, for sharing via care home networks and associations. Publications Realist synthesis protocol for understanding which strategies are effective to prevent urinary tract infection in older people in care homes Preventing urinary tract infection in older people living in care homes: the ‘StOP UTI’ realist synthesis | BMJ Quality & Safety Strategies for older people living in care homes to prevent urinary tract infection: the StOP UTI realist synthesis | NIHR Journals Library Link to University of Southampton site Research team: • Dr Jacqui Prieto, Joint Chief Investigator, University of Southampton • Professor Heather Loveday, Joint Chief Investigator, University of West London • Professor Jennie Wilson, Co-investigator, University of West London • Mrs Alison Tingle, Co-investigator, University of West London • Mrs Emily Cooper, Co-investigator, UK Health Security Agency • Dr Melanie Handley, Co-investigator, University of Hertfordshire • Professor Jo Rycroft-Malone, Co-investigator, University of Lancaster • Dr Lynne Williams, Co-investigator, Bangor University • Mrs Jennifer Bostock, Co-investigator, Patient and public involvement • Lois Woods, Information Specialist, University of Southampton • Simon Briscoe, Information Specialist, University of Exeter • Jemima Kakpa, Research assistant, University of Southampton • Christine Logan, Administrative assistant, University of West London Project Advisory Group: • Jennifer Bostock (Chair) • Professor Lona Mody • Mr Mark Stott • Dr Leah Jones • Mrs Susan Bennett • Mr James McMahon • Mrs Annabelle Stigwood • Mrs Anita Astles

65894af6-1d61-4f27-8b10-ff3b90451d8b COMPLETED: Safer Nursing Care Tool and nurse staffing requirements What did we learn We found that for some wards using the Safer Nursing Care Tool (SNCT) gives a good estimate of the number of nursing staff needed. However, for other wards, relying on the estimate provided by this tool without further thought could lead to unsafe staffing levels for different reasons. For example, the current guidance recommends setting staffing levels to meet the average requirement, but following this logic, 18 wards in the three Trusts would often have been short-staffed. Also, a quarter of wards needed a sample of over 182 days to estimate the number of staff needed precisely, when the current recommendation is 20 days. Nursing workforce leaders at the three Trusts suggested characteristics of wards where the tool performed least well, for instance, high patient throughput and differences in workload between mornings and evenings. What difference can this new knowledge make? This project and the previous related project (NIHR-funded study https://doi.org/10.3310/hsdr08160 ) led to a direct collaboration with NHS England and NHS Improvement and an invitation to work with them to further develop and update the guidance on using the Safer Nursing Care Tool. The team have spoken about the research findings and implications at a series of NHS Improvement safe staffing fellows training events. They have co-developed a set of resources to help nurses plan staffing. Impact has been achieved through this research shaping revised guidelines published by NHS England and NHS Improvement on using the SNCT in combination with professional judgement to determine nurse staffing requirements. We were invited to help facilitate workshops to co-develop a template for nurses to record their professional judgements. We are also in early-stage discussions with hospital managers in Greece about how the professional judgement framework might be relevant there, as well as discussions about how to achieve wider reach through the World Health Organization website. Why is this important? The professional judgement framework we developed as a result of these projects will benefit nurses, who use this tool nationally, by giving them concrete guidance on issues to consider when deciding staffing levels. It will benefit patients admitted to inpatient wards, through better matching of staffing levels to demand. Having too few nursing staff is related to adverse effects for patients (more deaths, more falls, longer stays in hospital), staff (turnover, sickness) and organisations (higher costs from temporary staff to fill gaps). Diagram 1 We presented the list of wards which were flagged as having overall poor fit to three nursing workforce leaders Some of the common factors they suggested as potential reasons for poor fit are shown here above. They highlighted wards with large morning-evening differences in staffing requirements (based on acuity-dependency ratings) may be among those where the tool fits least well. For wards that are particularly small or large, it is possible that the number generated by the SNCT is less likely to be sufficient to maintain minimum registered nurse levels when rostering staff to shifts. They highlighted some ward characteristics that mean the SNCT multipliers, as they are applied, may underestimate the true workload. These were high patient turnover, older patient population, cancer infusion/device activity. a high proportion of patients requiring one-to-one care AKA enhanced care/specialling. The factors suggested are on the whole congruent with published evidence What next? Our next step is conducting research predicting demand for nursing staff which we plan will also lead to tools and resources to guide decision-making around staffing. Research team: • Professor Peter Griffiths, Chair of Health Services, University of Southampton • Rosemary Chable, Deputy Director of Nursing, Education & Workforce, University Hospital Southampton NHS Foundation Trust • Nicky Sinden, Head of Nursing Workforce, Portsmouth Hospitals NHS Trust • Tracy Moran, Lead Nurse for Nursing Workforce, Education & Practice, Poole Hospital NHS Trust Project partners: • University of Southampton • University Hospital Southampton NHS Foundation Trust • Portsmouth Hospitals NHS Trust • Poole Hospital NHS Trust More information Evi dence Brief Publication 24_11_Professional_Judgement_Staffing_Eprints[16] .pdf Download PDF • 186KB Publications: Saville, Christina and Griffiths, Peter (2021) Ward staffing guided by a patient classification system: A multi-criteria analysis of “fit” in three acute hospitals. Journal of Nursing Management, 29 (7), 2260-2269. ( doi:10.1111/jonm.13341 ). Saville C, Griffiths P, Casey A, Chable R, Chapman H, Radford M, and Watts N (2023) Professional Judgement Framework, doi: 10.5258/SOTON/P1102 University of Southampton ( https://doi.org/10.5258/SOTON/P1102 ) Saville, Christina and Griffiths, Peter , Ejebu, Ourega-Zoé and Fogg, Carole (eds.) (2023) Introducing the Professional Judgement Framework to guide nurse staffing decisions (Evidence Brief, 24) 2pp. http://eprints.soton.ac.uk/id/eprint/484412 Saville, Christina and Griffiths, Peter , Ejebu, Ourega-Zoé and Fogg, Carole (eds.) (2024) Nurse staffing decisions: the Professional Judgement Framework. Nursing Times, 120 (7). https://www.nursingtimes.net/c...4-06-2024/ The Safer Nursing Care Tool as a guide to nurse staffing requirements on hospital wards: observational and modelling study ( nihr.ac.uk ) Video: Computer simulation what and why? https://sho.co/1E34T The importance of professional judgement in nurse staffing decisions https://southampton.cloud.panopto.eu/Panopto/Pages/Viewer.aspx?id=87fcb9bb-e9dc-4b43-8377-acb700e3bec2 Here is the orginal research outline Identifying wards for which the Safer Nursing Care Tool is appropriate for assessing nurse staffing requirements Principal Investigator: Dr Christina Saville Team members: Dr Christina Saville (Research Fellow, University of Southampton) Professor Peter Griffiths (Chair of Health Services Research, School of Health Sciences, University of Southampton), Rosemary Chable RN (Deputy Director of Nursing, Education & Workforce, University Hospital Southampton NHS Foundation Trust) Ms Nicky Sinden (Head of Nursing Workforce at Portsmouth Hospitals NHS Trust), Tracy Moran (Lead Nurse for Nursing Workforce, Education & Practice, Poole Hospital NHS Foundation Trust) Start: 1 December 2019 End: 1 August 2020 Partners: University of Southampton, Portsmouth Hospitals NHS Trust, Poole Hospital NHS Foundation Trust Lay summary It is important to have enough qualified (registered) nurses looking after patients staying on hospital wards, because having too few is associated with worse patient care and more patient deaths. On the other hand, there are extreme shortages of nurses, so having “too many” on a ward could be considered a waste. The Safer Nursing Care Tool is used in many hospital wards in England to work out the number of nursing staff (including nursing assistants) needed. However, a recent study showed that it is more suitable on some wards than on others. For example, we found that factors not accounted for in the tool, e.g. whether a ward is surgical or medical, and the proportion of single rooms, also affected professional judgement of whether staffing was adequate. Aim This study aims to understand which ward characteristics mean that the Safer Nursing Care Tool gives a good estimate of the nursing staff required, and which ward characteristics mean that the number might need to be adjusted or further considered by taking into account the expertise of ward leaders. It also aims, if possible, to provide some general rules or an add-on tool to help nursing managers with setting staffing levels. Methods We will analyse the data that were collected for a previous study in a different way. This time we will focus on differences between wards rather than hospitals. We will use analytical techniques for finding patterns in data to identify similar wards. In our team we have experienced leaders in nursing who will provide expert professional insights into ward characteristics. Patient, public and community involvement and sharing results We will involve nursing managers in the study because they are the potential users of any rules or tools we develop. We plan to develop a resource (rules or a tool) for nursing ward managers and to run a workshop to test use of this resource. We plan to write one academic paper about what we find out. We also can share the plans for this with lay members from the PPI group as appropriate. We are developing a smaller user group across Workforce and Frailty and Older People teams.

Research Fellow < Back Francesca Zecchinato Research Fellow Workforce & Health Systems Francesca Zecchinato is a recently appointed Research Fellow within the NIHR ARC Wessex Mental Health Hub at the University of Southampton. In her current role, she is working on a mixed-methods project to identify knowledge gaps among paramedics in managing patients presenting mental health conditions. This work aims to enhance the quality of mental health care provided to patients, improve patient experiences, and offer better support for paramedics. Francesca holds a BSc in Cognitive Psychology and Psychobiology (cum laude) and a MSc in Clinical Psychology (cum laude) from the University of Padova (Italy). She has completed her PhD at the Centre for Innovation in Mental Health, School of Psychology, University of Southampton, funded by the ESRC South Coast DTP and focused on the risk posed by parental anxiety to their children and on strategies to promote the mental health of children with anxious parents. Building on her previous research exploring the needs of parents with mental illness and how services can support their children’s mental health, Francesca’s work continues to focus on understanding the needs of individuals experiencing mental health difficulties and identifying evidence-based strategies to improve care delivery. Francesca uses both quantitative and qualitative methods in her research and poses great value in the involvement of experts by experience (via Patient and Public Involvement and Engagement) throughout the research process. Previous Next

54d3d6a4-2f97-4fa8-8c83-e41613f3b35d COMPLETED: 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'.

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

945aa457-32c2-485e-a4e6-687eee387f97 COMPLETED 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 Team: Dr Sarah Fearn, Senior Research Fellow, University of Southampton Starts: 1/2/2022 Ends: 31/07/24 Background The number of people living with a neurological condition is increasing, placing ever greater demand on existing services. The NHS Long Term Plan outlines a need for new service models to optimise care. Remote and digital technologies, aimed at improving efficiency and service delivery, can promote a more personalised approach to outpatient care, with a key outcome being a reduction of unnecessary appointments. ‘Remote care’ provides synchronous communication between the patient and the healthcare professional (HCP) across different locations. The COVID-19 pandemic accelerated the uptake of remote care with a rapid shift in appointments performed via phone or video-call. ‘Digital care’ provides technology-enabled asynchronous communication between the patient and their care team (e.g. messaging) where contact with an HCP is not required in real time. UHS has been a leader in developing digital care through the My Medical Record care platform that provides a unique digital tool connecting patients to their care team. Both remote and digital care provide cost effective, implementable opportunities to transform outpatient services in neurology and for other long-term conditions. Yet little is known about the most effective ways to combine the standard face-to-face appointment with remote and digital technologies to provide effective, efficient, high quality outpatient care. There has been some research into the advantages, disadvantages, barriers and enablers of remote care during the pandemic for people with neurological conditions (Nakornchai et al. 2021), with a growing body of work into digital healthcare and the moderating factors of its use and success within this population (Moccia et al. 2018). However, in a post-pandemic environment, we need to shift the focus from separate analyses of remote and digital care onto how best to combine face-to-face, remote and digital care to better serve patient needs and realise the ambitions of the Long Term Plan. Why this research matters During the COVID-19 pandemic, many outpatient neurology appointments were moved online or over the phone to keep people safe. Five years on, remote care is still widely used—but are we doing it well? We wanted to find out what works, what doesn’t, and how we can make remote neurology care better for both patients and healthcare professionals. What we did We analysed large national surveys about remote appointments from over 2,400 neurology patients and carers (via The Neurological Alliance’s national survey) and nearly 600 neurologists (via two surveys collected by the Association of British Neurologists). We also ran local focus groups and co-production workshops with patients, carers and healthcare professionals to understand what really matters in a neurology appointment. Together, we co-designed a set of practical, evidence-based recommendations to help services deliver better, more person-centred, and efficient remote neurology care. What people told us Remote care can be hugely beneficial when done well. Patients appreciated the convenience – avoiding travel, hospital parking and long waits - especially if they had mobility issues or lived far from the hospital. It also made it easier for carers or family members to join the appointment. But there were challenges. Patients worried they might not get the same quality of care without being seen in person. They were concerned about symptoms being missed, not being taken seriously, or struggling to explain themselves over the phone. Some felt remote appointments could feel rushed or impersonal. Patients were also concerned about maintaining their own privacy during the consultation and wanted to feel certain that their healthcare professional was also in a private space. Not all patients felt confident with video technology and weren’t sure what to do if things went wrong. Healthcare professionals also found remote working challenging at times — IT systems and technology weren’t always reliable and were clunky to use, finding a private room could be difficult, and it wasn’t always easy to ensure timely in-person follow up if a concern had been identified remotely. What we recommend Together with patients, carers, and professionals, we developed key recommendations to improve remote care: • Let patients choose the type of appointment that suits them—face-to-face, phone, or video—where it’s safe to do so. • Co-design clear, accessible tools and information with patients to improve trust in remote care and help all patients get the most out of their remote appointments. • Protect clinical staff time to keep digital platforms and patient resources up-to-date. • Implement fair and robust triage systems to reduce variation in care. • Provide regular training and support so staff can deliver the quality of patient care they aspire to. • Ensure there are enough private spaces for healthcare professionals to deliver confidential remote consultations. • Maintain enough rapid-access face-to-face slots to allow timely and safe in-person follow up when needed. • Improve digital systems and streamline admin to reduce stress, avoid unnecessary delays and boost satisfaction for both staff and patients. • Regularly review how remote services are working to make sure they’re fair and effective for all, especially those with less digital access or confidence. What’s next Remote care is here to stay. But for it to work well, it needs to be flexible, inclusive and built around patient and staff needs. We have shown that with the right systems, tools and support, remote neurology can deliver safe, high-quality and accessible services. These recommendations will not only optimise remote care in neurology but would also be adaptable to other clinical specialities across the NHS. What did we do with this new Knowledge? • Shared findings with patients and carers and healthcare professionals. • Informed content of the UHS outpatient webpages. • Provided national and local feedback to the UHS outpatient transformation team to inform strategy for remote care in neurology and more generally. • Used the positive feedback from our workshop participants to inform future approaches to Increase engagement and inclusion in research. • Drafted an article about optimising remote appointments in neurology for publication. What's next We will discuss the recommendations with the Association of British Neurology Quality Committee with regards to endorsement of the recommendations for a neurology clinical practice guideline. Once endorsed and put into practice, the next step would be to audit practice and measure change.

d6d7fb08-5eb7-4cab-afcf-359d64b8fe12 COMPLETED ADOPTED PROJECT: Young people’s barriers to mental health services Lead: Dr. Corine Driessens Co-Investigator: Professor Peter W F Smith Kim Markham Jones & Fiona Lacey – YoungMinds Nicole Davenport, Mahdi Hassan, Shahrbano Iqbal, Friday Skelton – young researchers recruited by and in employ of YoungMinds Starting date: October 2022 Ended: July 2025 Published in journal of psychiatric research online: Use or no use? Young People's engagement with mental health services https://doi.org/10.1016/j.jpsychires.2026.01.034 Many young people in the UK experience anxiety or depression, but most can’t get mental health support when they need it. From the very beginning of this project, young people, both as young researchers and as participants in four co-production workshops, played a central role in shaping our questions, interpreting the findings, and explaining what the results mean in real life. Their insight guided every stage of the work. This study looked at what affects whether young people use mental health services and what happens to those who don’t. The biggest factor in getting help was whether health care professionals recognized the young person’s distress was a mental health disorder. Other things like, severity of symptoms, being a female, having fewer supportive people around, or having unemployed parents played a smaller role. Young people who didn’t use services were less likely to be female, come from single-parent families, have caring responsibilities, or have been bullied. They were also more likely to have good relationships with their parents. Those who did use services had poorer outcomes later in adulthood, suggesting they faced greater difficulties overall. Because specialist mental health services are overstretched, responsibility has shifted to GPs and teachers, who often feel under-resourced and not fully trained to meet these needs. The GPs we spoke to faced strict referral rules, long waiting lists, short appointments, and limited mental health training. The teachers we spoke to also felt pressure to support students without the resources or guidance they need. After hearing these findings, a group of young people from the “missing middle” (those struggling but not qualifying for specialist care) recommended: Training all school and college staff in mental health. Better support for apprentices at work. Peer support groups in schools, colleges, and universities. Safe spaces and housing support for LGBTQIA+ students. More help for young carers and fairer benefits. Better training for all health workers to support diverse communities. Looser referral rules so young people don’t have to be “ill enough” to get help. Youth hubs offering safe spaces, activities, and mental health support. Overall, the findings show the need for more inclusive, preventative, and joined-up mental health support for young people. Reflections on Young People involvement with shaping analysis framework for mental health .docx Download DOCX • 2.37MB What did we find out? Presented the findings at national and international conferences (e.g. MQ/DATAMIND, ADRUK, NIHR Statistics Group, EPA Epidemiology & Social Statistics, International Congress of the European Society for Child and Adolescent Psychiatry) Presented the findings at ARC Wessex webinar Presented findings on ARC Wessex website Where next? The young people who took part in our workshops were very clear about one thing: we need to start much earlier. They told us that helping children learn emotional skills, like understanding their feelings, managing stress, and asking for help, before stigma takes hold could make a big difference in preventing mental health problems later on. Taking this guidance seriously, our team has now grown to include experts who know how to design effective mental health programmes for primary schools, as well as researchers who can identify exactly which elements such a programme should include. Our next step is to develop a primary school–based intervention shaped by what young people told us matters most. Because this type of work sits outside ARC Wessex’s remit, we are now seeking external funding to take the project forward and bring this early-intervention programme to life. Olly Parker, Head of External Affairs and Research at YoungMinds , said: “This research from YoungMinds and the University of Southampton shines a vital light on the record numbers of young people needing mental health support. Growing up today is incredibly tough. Many young people are experiencing multiple pressures which impact their mental health, including poverty, inequality, intense academic pressure and the online world, so it’s no wonder so many are struggling. One of the clearest recommendations from the young people involved is the urgent need for early support hubs in every community. We know many young people face long waits for mental health support and become more unwell while waiting, which can lead to needing more urgent care. We need major reforms to address the root causes of poor mental health and for the Government to focus on reducing waiting lists so young people can get the support they need. The recent 10 Year Health Plan showed promising commitments with Young Futures Hubs and Mental Health Support Teams. These initiatives are vital to reducing pressures on the system, improving support and reducing waiting times - their rollout must be a political priority. But more is needed to tackle the scale of need - we need radical solutions that will address the reasons why so many young people are struggling in the first place.” Corine Driessens, one of the researchers based in Southampton, said: “It has been a truly wonderful and positive experience working with these groups of young people. Their innovative and fresh ideas across a wide range of ways to help others get the mental health support they need have been inspiring.”