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3ace18ec-d7ab-47b5-898a-8030d0eb53f7 POST DOCTORAL PROJECT: Early detection of chronic liver disease in community settings Chief Investigator: Dr Kate Glyn-Owen – University of Southampton Project Team Members: Julie Parkes – University of Southampton, Dr Richard Aspinall – Portsmouth University Hospitals NHS Trust Organisations Involved: British Liver Trust, Portsmouth Football Club (Pompey In The Community), Portsmouth City Council public health team Background: Liver disease is the third biggest cause of early death in the UK. Two of the main causes of liver disease are drinking too much alcohol, which directly damages the liver, and being overweight, which can lead to fat building up in the liver and causing damage. If liver disease is detected early, it is possible to prevent disease progression, and in some cases to reverse damage done. This benefits patients and reduces impact on the healthcare system. The best way to detect liver disease early is not known. Tests and risk scores are available which use a simple blood test and information about the patient. These were developed in hospital settings, for people with known liver disease. They have not been used sufficiently in general population settings and we do not know how good they are at detecting liver disease in these settings. This project is investigating how these tests and scores perform in general population settings, using data from the UK Biobank, a big dataset from general population volunteers. We are exploring whether combining tests/scores with information about people’s risk factors, may improve detection of disease.We are going out to community settings, performing a risk assessment and simple scan for liver disease in populations at high risk. We are working with Portsmouth Football Club, the British Liver Trust and Portsmouth City Council public health team, to target populations at risk and to find out how effective we can be at early detection of disease in these settings.

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.

f1f73a06-b3fc-4e9d-b46d-0ecc2e946c91 PARIEDA - Prediction of Acute Respiratory Infection outcomes prior to Emergency Department Attendance Principal Investigator: Dr Daniel Burns, Senior Research Engineer, University of Southampton, d.burns@soton.ac.uk Team: Professor Michael Boniface, Professorial Fellow of Information Systems, University of Southampton, m.j.boniface@soton.ac.uk Professor Matthew Inada-Kim, National Clinical Director-Infection, AMR & Deterioration-NHS England & Improvement, National Clinical Lead COVID NHS@home Visiting Professor, University of Southampton Chair COVID pathways group, matthew.inada-kim@nhs.net Dr Stephen Kidd, Lead Healthcare Scientist, Hampshire Hospitals Foundation Trust, stephen.kidd@hhft.nhs.uk Starts: 1/4/2023 Ends: 30/9/2024 Aim: We will help community doctors and nurses decide how best to care for patients with serious respiratory illness. The right care depends on how ill a patient is and if they will get worse. Care may include home monitoring or hospital visits. We aim to use computer algorithms to help doctors and nurses make these decisions. We expect patients to avoid unnecessary trips to hospital and to feel more supported. Background: Hospitals have had record number of emergency departments visits. Respiratory infections are almost half of the visits. Many of these patients were not admitted to hospital. This means that some patients could be cared outside of the hospital in the community. COVID-19 is a serious respiratory illness. During the COVID-19 pandemic a new way to care for patients was created. Instead of patients going straight to hospital, they were assessed in the community. Only the most serious cases were then sent to hospital. Community care and assessment is now being considered for other respiratory illnesses. Approach: We will use computer algorithms to help community doctors and nurses decide which patients are at most risk of serious respiratory illness. Risk assessment will be done using machine learning. Machine learning is a way to train a computer to categorise patients into groups using data about patients and services they use. We will use historical hospital data to identify patients in high-risk groups. The patient categories will then be used to inform community decisions before attendance at hospital. Patient and Public Involvement: Patients and public have helped develop the research through evaluation pilots for community assessment hubs. PPI will influence data usage and the use of risk groupings within care pathways. Two public members will participant in a Steering Committee. A PPI Committee will organise three workshops involving ten patients and public in the research. Dissemination: Communication will engage the public and decision makers. We will work with patients and the public to design engaging communication and seek acceptance. Our results will be published and will inform national policy.

bd368e62-bd41-4d7a-a7ea-673ea3582964 ADOPTED PROJECT: High Harm Domestic Violence Perpetrator Pilot Evaluation Chief Investigator: Dr Sara Morgan – University of Southampton Project Team Members: Mrs Katerina Porter – University of Southampton, Mrs Fiona Maxwell – University of Southampton, Professor Julie Parkes – University of Southampton Organisations Involved: Hampshire County Council, Hampshire Constabulary, Office of the Police and Crime Commissioner, Hampshire, The Home Office Background Home Office funding has been awarded to a multi-agency partnership in Southampton and Hampshire, to pilot a model of workforce development, new approaches and pathways for perpetrators of domestic violence and abuse (DVA).As part of this work, the High Harm Domestic Violence Perpetrator Pilot Evaluation pilot aims to facilitate and promote early identification and engagement with perpetrators of DVA, who are deemed to pose a high risk of harm to their victims and families. Evidence suggests that perpetrators in the 18-24 age group are most difficult to engage in positive behaviour change programmes.This is also an age group where high levels of harmful behaviour are seen. This mixed methods evaluation is aimed at evaluating the extent to which front-line practitioners feel more equipped to engage with perpetrators (‘DARE’ training) following training and to evaluate the identification, referral and engagement of perpetrators who meet the agreed criteria; and monitoring/disrupting of those who are not willing to engage with the behaviour change intervention (‘Operation Foundation’ scheme).

Dr Naomi Klepacz & Professor Jane Ball (School of Health Sciences, University of Southampton) < Back Addressing underlying workforce challenges is essential to meet the nation’s mental health care needs Mental Health Dr Naomi Klepacz & Professor Jane Ball (School of Health Sciences, University of Southampton) What is it like to be part of the mental health nursing workforce? We argue that it is only by understanding the reality of the job – its highs and its lows – that we will be able to grow the mental health workforce and hold on to experienced nurses needed to deliver care well. Demand for mental health services is at an all-time high, yet many people cannot access vital services and face long waits for treatment ( 1) . Nurses comprise one-in-three of the NHS mental health workforce (2) . They are fundamental to providing mental health services and a positive patient experience. However, mental health nursing vacancies represent a third of all nursing vacancies (3) , and while there has been a welcome increase in the number of mental health nurses in recent years, the rate of increase still falls behind that seen in adult and children’s nursing (2) . There are also significant regional differences in mental health nurse staffing that seem disconnected from the level of demand for services (2) . The bottom line is that both now and, in the future, we need more nurses working in mental health – which means expanding supply and ensuring we have the conditions needed to retain the experienced staff we already have. The NHS Long Term workforce plan proposes an investment in expanding training places by 2028/29, with a promised increase of 38% for mental health nursing (4) . A substantial change, but lower than that promised to other fields of nursing. Research has demonstrated the link between nurse wellbeing and patient experience of care, staff and patient safety, sickness absence, job satisfaction and leads to staff leaving the workforce (5) . Physical or mental health, burnout or exhaustion currently follow retirement as the top reason nurses leave the profession (6) . The 2022 NHS Staff Survey reports that 49% of mental health nurses felt unwell because of work-related stress in the last 12 months, 61% came to work despite not feeling well enough to perform their duties, 45% reported often or always finding their work emotionally exhausting, and 28% experienced physical violence from a patient or service user in the last 12 months. In addition, 70% work additional unpaid hours over and above their contracted hours. Therefore, understanding the working lives and wellbeing of the mental health nursing workforce is critical for patient care quality, patient nurses, and the growing nursing workforce. Change is urgently needed to meet the nation’s demand for mental health care, but change requires commitment, investment, and, above all, an understanding of, and sensitivity to, the underlying issues. NHS England made a commitment to the growth and development of mental health nursing (7) , and recommendations from this report together with those from the Nuffield Trust (2) say a more accurate and realistic image of the mental health nursing role is needed, with clarity on career options, work setting and the range of people mental health nurses care for, to challenge false stereotypes. In our research into the working lives and wellbeing of nurses in mental health, we have spoken to some truly inspirational nurses who describe working as a mental health nurse as “the best job in the world”. While both patients and nurses place value on therapeutic relationships (8) , the importance of these relationships appears to be poorly understood by those who have not been touched by this experience (9) . Yet the absence of such relationships in mental health care can impact both patients (who may feel more disconnected, alone or vulnerable) and nurses - who are less likely to feel job satisfaction or take pride in the care provided ( 8 , 10 ). Unlike other fields of nursing, mental health nurses argue that it is this patient familiarity, the knowledge and experience gained through patient interaction, rather than treatment-focused ‘skills’ that make mental health nurses unique and indispensable while also making the role of mental health nurses challenging to define and difficult to evidence. Nurses don’t just deliver the intervention; they are the intervention. This is why we are undertaking a study (with funding from the NIHR ARC Wessex Mental Health Hub ) to provide insight into the work lives, wellbeing and working context of nurses in mental health services so that action can be taken (through local changes and/or national policy) to enable a better experience of work. When nurses feel good about the work they do and are given what they need, the benefits – to staff, organisations, and patients – are many. As part of this work, a national survey of the mental health nursing workforce is currently underway. This survey is open to nurses on the Nursing and Midwifery Council (NMC Register) providing mental healthcare to any patient group, in any setting, and for any health and social care provider. It is completely anonymous and will take 15-20 minutes to complete. This study is supported by the National Institute for Health and Care Research ARC Wessex. The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health and Care Research or the Department of Health and Social Care. Professor Jane Ball Dr Naomi Klepacz References: 1. Care Quality Commission. Rising demand for mental health care [Internet]. 2022. Available from: https://www.cqc.org.uk/publications/major-reports/soc202021_01d_mh-care-demand 2. Palmer W, Dodsworth E, Rolewicz L. In train? Progress on mental health nurse education [Internet]. Nuffield Trust; 2023 May. Available from: https://www.nuffieldtrust.org.uk/sites/default/files/2023-05/Mental%20Health%20nursing%20update_WEB_FINAL.pdf 3. NHS Digital. NHS Vacancy Statistics England, April 2015 - March 2023, Experimental Statistics [Internet]. 2023. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-vacancies-survey/april-2015---march-2023-experimental-statistics 4. NHS England. NHS Long Term Workforce Plan [Internet]. 2023 Jun. Available from: https://www.england.nhs.uk/wp-content/uploads/2023/06/nhs-long-term-workforce-plan-v1.2.pdf 5. Maben J, Adams M, Peccei R, Murrells T, Robert G. Patients’ experiences of care and the influence of staff motivation, affect and well-being. NIHR; 6. Nursing & Midwifery Council. 2023 NMC Registere Leavers Survey (Summary Report) [Internet]. Nursing & Midwivery Council; 2023 May [cited 2023 Jul 10] p. 1–36. Available from: https://www.nmc.org.uk/globalassets/sitedocuments/data-reports/may-2023/annual-data-report-leavers-survey-2023.pdf 7. Health Education England. Commitment and Growth: advancing mental health nursing now and for the future [Internet]. Health Education England; 2022 Apr p. 37. Available from: https://www.hee.nhs.uk/sites/default/files/documents/Commitment%20and%20Growth%20Advancing%20Mental%20Health%20Nursing%20Now%20and%20for%20the%20Future.pdf 8. Simpson A, Hannigan B, Coffey M, Barlow S, Cohen R, Jones A, et al. Recovery-focused care planning and coordination in England and Wales: a cross-national mixed methods comparative case study. BMC Psychiatry. 2016;16(147). 9. Clarke L. The therapeutic relationship and Mental Health Nursing: it is time to articulate what we do! J Psychiatr Ment Health Nurs. 2012;19:839–43. 10. Coffey M, Hannigan B, Barlow S, Cartwright M, Cohen R, Faulkner A, et al. Recovery-focused mental health care planning and co-ordination in acute inpatient mental health settings: a cross national comparative mixed methods study. BMC Psychiatry. 2019;19(115). Previous Next

3020cd35-d002-4b24-bc53-5ac051771722 Adopted Project: Paramedic delivery of end-of-life care: a mixed methods evaluation of service provision and professional practice (PARAID) Chief Investigator: Dr Natasha Campling, University of Southampton Funder: Marie Curie Research Grants Scheme Start Date: 1st March 2023 End Date: 7th October 2025 Partners: Research & Development Department, South East Coast Ambulance Service, University of the West of England, University of Southampton Summary Paramedics are often important to patients in the last year of their life (end-of-life). We know that 999 calls are increasing for individuals and their families at end-of-life, which may be because services in the community are under pressure e.g. those provided by family doctors and community nurses. Little wide scale research has been carried out to understand the contribution played by paramedics in these situations and how this might be improved. From practice it is known that paramedics attending patients at end-of-life face complex issues such as: not knowing the patient or their family, lack of availability of patient history, fear of doing wrong, issues with family conflict and a lack of healthcare professionals to hand over to out-of-hours if the patient is to remain at home. These issues can mean people are admitted to hospital when circumstances mean they could be cared for at home. The purpose of the study is to evaluate services and care provided by paramedics to people in the last year of life. We will survey paramedics throughout England to understand their professional practice and what factors influence this and conduct in-depth case studies (collecting information from patients, carers and healthcare professionals) to examine different ways of delivering services and how these shape paramedic decision-making and management of risk. It is important to evaluate service delivery and understand how the best service features can be incorporated into other services to improve the quality of care and support provided to patients and their families. This may prevent unnecessary hospital admissions at end-of-life, which often leads to people dying in hospital when most people state they would prefer to be cared for, and die, at home. The research will describe, characterise and evaluate paramedic delivered end-of-life service provision to answer the research question: how do different models of service provision shape paramedic practice and influence experiences and outcomes for individuals at end-of-life? The evaluation will enable service delivery models, their features, and effective risk management by paramedics to be distinguished to facilitate sharing of best practice and improve the quality of care and support for people at end-of-life.

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.

9cf70c4f-6d1c-4acf-8a29-5aa00565f951 ADOPTED (PhD): PREPARE-to-ACT study: Preparing for and Responding to Emergencies – A multi-phased qualitative investigation of Patients’ And members of their RElational networks’ decisions to use urgent and emergency care during Anti-Cancer Treatment Principal Investigator: John Defty, University Hospital Southampton NHS Foundation Trust Start: September 2022 Ends: September 2026 Background Complications of anti-cancer treatment can be life threatening . Anti-cancer treatments, including chemotherapy, radiotherapy, and immunotherapy, are increasingly provided on a day-case basis , meaning that complications occur at home and necessitate a response from urgent and emergency care services . Evidence suggests people receiving anti-cancer treatment delay seeking help despite access to dedicated emergency care (acute oncology services) . Focus of research to date has been for what reasons and when , rather than how and why, people with cancer use these services. Evidence suggests patients and informal carers rely on prior instructions from cancer specialists to identify and interpret the severity of complications but find relating to this information difficult when acutely unwell . Emergency ‘contingency planning’ was identified as a priority for improving the safety of anti-cancer treatment but, there are few studies that describe how pre-treatment emergency planning influences help-seeking for complications of anti-cancer treatment . With the number of people eligible for anti-cancer treatment expected to rise by two million by 2040, the need for research is now urgent. Results from our scoping review (completed; drafted for publication) suggest preparing for and making sense of urgent and emergency care is hard work for people with cancer. It also revealed poor understanding of how this work might differ for people receiving different types of treatment. This study aims to address these gaps by answering the question: ‘How do patients and informal carers prepare and seek help for complications of different anti-cancer treatments?’

53b76e5e-c361-4791-8e01-f147de703463 SOCIAL CARE: Evaluation of Southampton City Council’s Male Engagement Worker (MEW) Project Chief Investigator: Dr Michelle Myall, Principal Research Fellow, University of Southampton Co-Investigators: Dr Sophia Taylor, Senior Research Assistant, University of Southampton; Dr Susi Lund, Visiting Research Fellow, University of Southampton Partners who will collaborate on the research: Anjelica Finnegan, Senior Male Engagement Worker, Southampton City Council; Caroline Bate, Domestic Abuse Coordinator, Southampton City Council; Colin McAllister, Senior Public Health Practitioner, Southampton City Council; Francesca Mountfort, Male Engagement Worker, Southampton City Council Start Date: 19 October 2023 End date: 30 September 2024 Why is this research needed? An estimated 2.4 million adults experienced domestic abuse in 2019 in England and Wales. In April 2021 the Domestic Abuse Act was introduced in England and Wales. This created a new definition of domestic abuse to include “any incidents or patterns of incidents of controlling, coercive, or threatening behaviour, violence or abuse between those aged 16 or over, who are or have been, intimate partners or family members regardless of gender or sexuality. Domestic abuse can encompass, but is not limited to psychological, physical, sexual, financial and emotional abuse”. The Act required local authorities to expand their support and provision available to those experiencing domestic abuse. As part of a review by Southampton City Council into whether it meets the requirements of the new Act it found that alleged perpetrators of domestic abuse are not being effectively assessed or adequately supported. This is particularly true of young (step-) fathers. To address this gap, in 2020 Southampton City Council established a Male Engagement Worker (MEW) Project to work with high-risk male perpetrators of domestic abuse who have (step-) children and have local authority children’s services involved. This newly established service has yet to be evaluated. What are the aims? To evaluate Southampton City Council’s new domestic abuse service focusing around the newly created Male Engagement Worker Project. How will the study be carried out? We will carry out interviews with key informants and relevant stakeholders and analyse audit data collected about the service. What will happen to the findings? We will work with our project partners to identify who we need to engage and how to reach them. We will share findings with stakeholders through a presentation. We will produce a report and executive summary of findings and recommendations for Southampton City Council and share learnings with other relevant local authority and third sector organisations. Findings will also be reported on social media posts for the wider public, publications in academic and professional journals and attendances at conferences.

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

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

Talia Emmanuel is a PhD candidate in the Health Workforce & Systems research group at the University of Southampton. < Back What do nurses want? Improving nurses’ shift patterns - where do we start? Talia Emmanuel is a PhD candidate in the Health Workforce & Systems research group at the University of Southampton. Talia Emmanuel is a PhD candidate in the Health Workforce & Systems research group at the University of Southampton. In this blog, she summarises some key results from her recent research paper that explored nurses’ views and values around their shift patterns and working time. Talia Emmanuel -University of Southampton. As a PhD student, one must be well-prepared to answer the question…“What is your research about?”. I typically answer with “I’m trying to find ways of improving shift patterns for nurses when they’re working in hospital”. Enthusiastic nods usually follow, along with a quippy reply: “Wow, that sounds important and complicated ”. Although simply put, “important and complicated” neatly summarises the nuances of this topic. We recognise the significance of improving nurses’ working conditions in the context of persistent health workforce shortages, both nationally and internationally. However, we also realise that singular cure-all solutions are non-existent – there are too many factors at play. So, where do we start? Some of those complicating factors centre around how nurses’ working hours are organised. In hospitals, nurses often have to work in shifts that cover different periods of the 24-hour day. Previous research has identified various repercussions of working shifts (and in particular, working long shifts of 12-hours or more and night shifts): increased burnout , poor work-life balance , and risk of chronic illness and cancer on the long-term. Impacts to nurses’ performance and safety while at work have also been flagged, which pose knock-on effects on the quality of care patients ultimately receive. Despite these risks, shift work is a necessary reality for many nurses working in hospitals. Therefore, administrators and managers are tasked with organising nurses’ shifts into rotas that balance staff wellbeing with service demands and operational costs - and this is no easy feat. Further complications come from recent increased pressure on NHS employers to offer staff more say over their working patterns as a way of improving job satisfaction and their experiences of work. But this raises the question: What do nurses want? More specifically, what shift patterns do they prefer, and why? While there is some existing literature on this (an excellent summary can be found here ), our understanding of the factors that lead nurses to prefer certain shift patterns needs more work. As part of my doctoral research, I was eager to do a deep-dive into this area: I know that in order to find ways to improve nurses’ shift patterns, it is crucial to ask nurses themselves about their views and values around the organisation of their working hours. Fortunately, I had access to a rich data source around this topic: a recent survey study funded by the NIHR ARC Wessex that collected responses from nurses working across the UK and Ireland. My supervisors and I were particularly interested in nurses’ responses when asked: “ If you could choose your shift patterns, what would be the most important factor in that choice?” While we expected nurses to describe many diverse factors/preferences, we were hopeful of commonalities too. Nearly 800 nurses provided their open-ended responses to this question. We analysed all of them and developed 3 overarching themes: Theme 1, “When I want to work ”: Nurses shared many preferences for when they wanted to work, and equally, how they wanted their rest days to be arranged. Even though individual preferences differed, three general scheduling practices were also repeatedly mentioned as helpful: working less ‘harmful’ shift patterns from the start, working more consistent/predictable patterns, and having more flexibility and control over when to work. “Not working consecutive shifts so that I am exhausted by the time I get a day off.” “Know what I am doing each week, either set days or set nights, so I can predict what I am working…” “Having the freedom to give myself more days to recover between weekly shifts.” Theme 2, “Impacts to my life outside work” : Many factors emerged from nurses wanting shift patterns that enable a good work-life balance and minimise disruption to their lives outside work. Their preferences and priorities related to wanting quality recreational time with family and friends, to be able to arrange childcare easily and inexpensively, and having enough rest/recovery time to protect their own wellbeing. “Quality time with my children and family without being permanently drained, exhausted, and sad” “That the pattern could stay the same each week so it would be easier for childcare needs. Many nurseries like set days and when our rota is changing from week to week this can be difficult.” “…Not mixing days and nights in a week […] this does not observe HSE best practice guidelines and messes with the body clock and sleep patterns. It should not be allowed to happen.” Theme 3, “Improving my work environment” : Some nurses mentioned job-specific factors that influenced their choices, like wanting to work the shift patterns they believed to be best for patient care, or, working the best configuration of shifts for optimal take-home pay. But other concepts, like having sufficient staffing numbers and being able to take breaks, were also stressed. “A shift where I feel I have accomplished the care I have wanted to give for my patients” “To not have so much pressure on the shift, with the right amount of staff on and to take my break when needed”. When thinking back to the question “What shift patterns do nurses prefer, and why?”, these themes provide several helpful clues. They also highlight that while there is variation in nurses’ specific shift preferences, there are also more general scheduling practices that also support their priorities. For my research, this finding is particularly striking, as it moves away from the oft-assumption that there are “countless individual preferences that are difficult to accommodate” and toward the idea that there are more universal preferences too. Moreover, when these universal preferences are used during the scheduling process, nurses’ shift patterns can be improved overall. That sounds like a good starting point! Read our full analysis of nurses’ survey responses in the open-access research paper here Follow Talia: Twitter/X | ResearchGate Follow the UoS Health Workforce & Systems team: Twitter/X | UoS website Previous Next