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ADOPTED PROJECT: Developing and testing a Patient Report Experience Measure for patients accessing Acute OnCology services: The PREMAC study Principal Investigator : Dr Richard Wagland, Senior Research Fellow, University of Southampton, School of Health Sciences Co-Investigators : Professor Alison Richardson, Professor of Cancer Nursing & End of Life Care and Director of NIHR ARC Wessex, University of Southampton & University Hospital Southampton John Defty, Advanced Clinical Practitioner in Cancer Care, University Hospital Southampton Dr Emma Brown, Medical Oncologist, Acute Oncology Lead. University Hospital Southampton Start date : January 2023 End Date: May 2024 Funder : University Hospitals Southampton (UHS) NHS Foundation Trust R&D Small Grants Award Lay summary People with cancer often need to access acute oncology (AO) services for serious problems caused by their disease or treatment. This study will co-design a questionnaire, involving patients, staff and researchers, to measure patient experience. Findings from surveys that use this questionnaire can inform service improvements. The research will produce a questionnaire and a protocol on how best to manage data collection processes and do the groundwork for a future grant application to distribute and test the questionnaire in services in Wessex and across England. Findings from exercises that use this questionnaire can establish and compare the quality of patient experience across services and inform improvements. Background Hospitals have established structured pathways for managing patients with oncological emergencies through acute oncology (AO) services. Whilst some Trusts have developed local questionnaires specific to that service there is no survey available to measure and compare patient experience across NHS trusts. This study will co-design a patient-reported experience measure (PREM), intended to be adaptable for use across different AO service models. Advisory Group Members : Andrew Dossett, Lead Clinical Advanced Clinical Practitioner for Acute Oncology Service, University Hospital Southampton Jane Winter, Macmillan Lead Nurse, Wessex Cancer Alliance Laura White, Head of Involvement & Participation, University Hospital Southampton Katie Hudson, Lead Advanced Clinical Practitioner for Cancer Care Wards, University Hospital Southampton Mrs Susan Restorick-Banks (PPI Representative) Mrs Anne Ongley (PPI Representative) Alison Keen, Head of Cancer Nursing, University Hospital Southampton Philippa Jones, Acute Oncology Nurse Advisor, Board Member of UK Acute Oncology Society. Prof. Ernie Marshall, Medical Oncologist, Wirral University Teaching Hospital (Clatterbridge) NHS England national lead for Acute Oncology

Courses and resources Seminar, courses and w orkshops Read more Resou rces for finding a mentor Read more Information on organisations that can help with your research application Read more Home > About us A guide to starting out in clinical academic research A guide to starting out in clinical academic research Play Video Share Whole Channel This Video Facebook Twitter Pinterest Tumblr Copy Link Link Copied Search video... Now Playing What is a clinical academic career #1 07:42 Play Video Now Playing Forming your team #2 05:17 Play Video Now Playing Finding a Mentor #3 04:10 Play Video Seminar, courses and workshops Seminars Senior Statistician - Dr David Culliford chairs a workshop explaining what tools and methods can be useful in statistical analysis in research Short courses Details of our short courses coming soon... Seminar Resources for finding a mentor As part of our support for anyone wanting to become a Clinical Academic we have gathered some information that can be useful in finding a mentor: Resources: Before embarking on a mentoring relationship: https://www.nihr.ac.uk/documents/before-embarking-on-a-mentoring-relationship/27682 Beginning the mentoring relationship: https://www.nihr.ac.uk/documents/beginning-the-mentoring-relationship/27692 The Professional Mentor blog: https://www.theprofessionalmentor.com/blog.html Finding a mentor: Does your clinical Trust or academic partner institution offer a mentoring scheme? All doctoral and post-doctoral ICA awardees can access free, 1:1 clinical academic career mentorship through the mentorship scheme: https://www.nihr.ac.uk/explore-nihr/academy-programmes/hee-nihr-integrated-clinical-and-practitioner-academic-programme.htm#six For postdoctoral NIHR Academy Members, the NIHR Leaders Support and Development Programme is available: https://www.nihr.ac.uk/explore-nihr/academy-programmes/nihr-leaders-support-and-development-programme Resources for finding mentor Org that can help Information on organisations that can help with your research application Academic Health Science Networks Academic Health Science Networks are partnership bodies that bring together all partners across a regional health economy to improve the health of local communities. There are 15 Academic Health Science Networks (AHSNs) across England, established by NHS England in 2013 to spread innovation at pace and scale – improving health and generating economic growth. Each AHSN works across a distinct geography serving a different population in each region. The AHSNs are: East Midlands Eastern Health Innovation Manchester Health Innovation Network Imperial College Health Partners Kent, Surrey and Sussex North East and North Cumbria Innovation Agency: Academic Health Science Network for the North West Coast Oxford South West UCLPartners Wessex West Midlands West of England Yorkshire & Humber Each AHSN works within its own area to develop projects, programmes and initiatives that reflect the diversity of our local populations and healthcare challenges. However, we all share the following priorities: Promoting economic growth: fostering opportunities for industry to work effectively with the NHS Spreading innovation at pace and scale: creating the right environment, and supporting collaboration across boundaries Improving patient safety: using knowledge, expertise and networks to bring together patients, healthcare staff and partners to determine priorities and develop and implement solutions Optimising medicine use: ensuring that medication is used to its maximum benefit – improving safety and making efficient use of NHS resources Improving quality and reducing variation: by spreading best practice we increase productivity and reduce variation, thereby improving patient outcomes Putting research into practice: our strong links with academia mean we are uniquely placed to support the translation of research into clinical practice Collaborating on national programmes. NIHR Applied Research Collaboration Wessex NIHR Applied Research Collaborations (ARCs) support applied health and care research that responds to, and meets, the needs of local populations and local health and care systems. The NIHR ARC Wessex is one of 15 ARCs across England, part of a £135 million investment by the NIHR to improve the health and care of patients and the public.

Training & Development At the ARC Wessex Academy we provide training opportunities and access to career development as part of our 5 years of research funding from the National Institute for Health Research (NIHR). ​ There is an opportunity to become an ARC Wessex Member which allows you access to funding, research tools, support and expertise. We value our Faculty Members because they bring the skills and support we need as a research collaboration, and expand the capacity for research in Wessex. ​ You can learn more about becoming a Member here . ​ Explore the NIHR Academy ​ What is a clinical academic career #1 Play Video Forming your team #2 Play Video Finding a Mentor #3 Play Video What Makes a Good Application #4 Play Video Developing your training plans #5 Play Video Public and patient involvement #6 Play Video The Interview #7 Play Video Intellectual Property and Enterprise #8 Play Video A guide to starting out in clinical academic research Watch Now Forming your team #2 Play Video Share Whole Channel This Video Facebook Twitter Pinterest Tumblr Copy Link Link Copied Share Channel Info Close Fellowships & internships Read more Meet our interns, PhD, and Post-Docs Read more Case Studies Read more ARC qualitative network Read more

ADOPTED PROJECT: Development, evaluation and provision of an intervention for primary and community NHS staff to help carers and homecare workers supporting people living at home with dementia with their continence. NIHR Three Schools Dementia Research Programme: NIHR School for Social Care Research, NIHR School for Primary Care Research and NIHR School for Public Health Research Team Lead investigator : Dr Cathy Murphy, Senior Research Fellow, School of Health Sciences, University of Southampton Co-i: Prof Mandy Fader, Professor of Continence Technology, School of Health Sciences, University of Southampton Co-i: Prof Miriam Santer, Professor of Primary Care Research, Faculty of Medicine, University of Southampton, NIHR School for Primary Care Research, Bournemouth based GP Co-i: Dr Leanne Morrison, Lecturer in Health Psychology, School of Psychology & Primary Care Research Centre, University of Southampton, NIHR School for Primary Care Research Co-i (PPI): Jane Ward, Alzheimer’s Society Research Network Member, co-founder of Dementia Friendly Hampshire, Patient Research Ambassador Co-i: Prof Jill Manthorpe, Professor of Social Work, Director of NIHR Policy Research Unit in Health & Social Care Workforce, King’s College London – Associate Director of NIHR School for Social Care Research Start date: 1st June 2022 End date: 28th Feb 2024 Summary Most of the 850,000 people living with dementia in the UK live in their own homes with support from family or friend carers. Dementia puts people at much greater risk of developing continence problems (with urine/wee or faeces/poo) than people without dementia of the same age. Continence and toilet-use difficulties cause many problems for both people living with dementia and carers, for example, sore skin, infections, embarrassment, anxiety, fear of going out, relationship breakdown, and expenses such as cleaning carpets or laundry. Dementia can mean that using pads or reminders do not work well for people as time goes by. Many carers find dealing with incontinence hugely distressing. They describe feeling poorly prepared and alone. Many find it difficult to talk about and want better support from health and care professionals. Recently we asked people living with dementia, carers and nurses to tell us what information and support they would find useful. From that, we developed a detailed, practical handbook specifically for carers, covering: understanding why someone with dementia might become incontinent helping people keep ‘dry’ managing incontinence talking about incontinence continuing with daily activities and socialising. The handbook contains many ‘real-world’ quotes from carers and will be made freely available on www.continenceproductadvisor.org (an NHS endorsed website). This is a good start but requires carers to find and use the handbook by themselves. Most carers want proactive support from the professionals they see (either healthcare or homecare workers), but healthcare professionals often feel ill-equipped to help carers or advise homecare workers. Therefore, in this study, we will develop a new resource that will build on the handbook and equip healthcare professionals to: start conversations with carers and homecare workers discuss continence problems and help people choose goals deliver practical advice to carers and homecare workers. To do this, first we will review research on similar resources and speak to up to 45 primary and community healthcare professionals and homecare workers to fully understand their needs and how a new resource could be used and useful. We know that many people living with dementia and carers have regular contact with homecare workers who often help with washing and going to the toilet. Then, we will work with carers, people living with dementia, healthcare professionals, homecare workers, care commissioners or funders, voluntary groups and professional bodies to develop the resource. We will ask up to 60 people living with dementia, carers, homecare workers and healthcare professionals to use the resource and tell us what they think. We will then make changes to improve the resource. We want this resource to be used by as many primary and community healthcare professionals as possible so that they can support homecare workers and family carers. So, throughout this project, we will ask people about the best way to make it both useful and accessible. It will be freely available via www.continenceproductadvisor.org and we expect adopted and recommended by a range of organisations such as the Alzheimer’s Society, Skills for Care, Homecare Association and professional groups.

Fit with Health and Social Care Systems 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: Project Outputs This domain helps you consider how implementation of your project output(s) fit with the changing needs of the health and social care systems and local, regional and national directives and policy. NHS Dorset Integrated Care System (ICS) Hampshire and Isle of Wight Integrated Care System (ICS) NHS Trusts Dorset County Hospital NHS Foundation Trust Dorset HealthCare University NHS Foundation Trust Hampshire Hospitals NHS Foundation Trust Isle of Wight NHS Trust Portsmouth Hospitals University NHS Trust University Hospitals Dorset NHS Foundation Trust Salisbury NHS Foundation Trust Solent NHS Trust Southern Health NHS Foundation Trust University Hospital Southampton NHS Foundation Trust Universities Bournemouth University University of Portsmouth University of Southampton University of Winchester Research partners Health Innovation Wessex (formerly Wessex Academic Health Sciences Network) What should I consider for my project? 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 Case study Parkinson’s disease Charity Community Outreach Project (PCCOP) team "We took time to understand how the aims of our project related to local and national policy and research on improving awareness of Parkinson’s disease in the community. We also spoke to other people within our local networks about their awareness of projects relating to the topic. Because of this, early on we realised there was a project with similar aims being undertaken by another local organisation. Though this was a challenge, as we had taken time to speak to people within our local networks, we had the opportunity to consider whether our project would be able to offer something different. We realised that though the projects had similar aims they were involving different stakeholder groups. We were also able to attend learning events from the other project to understand which steps may be helpful to repeat and avoid in our own project. This was invaluable as it saved both time and resources of those involved. It also ensured that our project fitted with local and national aims and provided something of real benefit and value to our local community.” Take away tips Implementation has a greater chance of success if it fits with the changing needs and priorities of the health and social care systems into which it is being introduced Involvement of stakeholders is key to identifying and understanding fit

Long Term Conditions publications Beyond individual responsibility: Exploring lay understandings of the contribution of environments on personal trajectories of obesity Serrano-Fuentes N, Rogers A, Portillo MC Reversing the upward trajectory of obesity requires responding by including the multiple influences on weight control. Research has focused on individual behaviours, overlooking the environments where individuals spend their lives and shape lifestyles. Thus, there is a need for lay understandings of the impact of environments as a cause and solution to obesity. This research aimed to understand the influence of environments on the adoption of health practices in adults with obesity and to identify lay strategies with which to address environmental barriers to behaviour change. https://doi.org/10.1371/journal.pone.0302927 May 2024 Long Term Conditions Interventions to Foster Resilience in Family Caregivers of People with Alzheimer's Disease: A Scoping Review. Santonja-Ayuso L, Corchón-Arreche S, Portillo MC The family caregiver of a person with Alzheimer's disease still experiences, in most cases, negative consequences in their biopsychosocial environment, which are related to the acquisition of this role. However, it has been observed that this fact is not universal in this type of population since benefits can be obtained in the act of caring through the development of resilience. Given this possibility and given that nurses are the health professionals who support people in this illness process, there is an urgent need to identify which non-pharmacological interventions could improve or promote resilience in family caregivers of people with Alzheimer's disease. https://doi.org/10.3390/ijerph21040485 April 2024 Long Term Conditions Methodological Proposal for the Adaptation of the Living with Long-Term Conditions Scale to the Family Caregiver Marín-Maicas P, Portillo MC, Corchón S, Ambrosio L Caring for people living with LTCs has a negative impact on the quality of life of caregivers, affecting their psychological, emotional, social, physical, and financial well-being. Evaluating how the family caregivers live with LTC can provide social health professionals with important information when planning interventions that favor better living . Therefore, it would be useful to have a tool available that allows for objectifying the degree to which people live with LTCs, for both the individuals affected by LTCs and the family caregiver. Presently, many scales exist that allow for measuring different concepts in family caregivers.However, although an instrument exists that measures the degree of living with LTC, according to the people with LTCs the “Living with Chronic Illness Scale” , no instrument was found that measures the degree of living with LTCs of family caregivers that includes all the dimensions that shape said process. This gap in the literature, in relation to measurement instruments that evaluate how the family caregiver experiences living with LTCs, is the common thread in this work. Based on an instrument created for people living with LTCs, an adaptation of this scale was planned to extend the reach of the instrument to family caregivers. Numerous recommendations exist on the process of adaptation of a scale to a context different from which it was created, but the available guides only refer to the methodological process for their transcultural adaptation, and especially to the guidelines established that allow the use of the scale in a language that is different from the one used for its creation. However, no specific system with the necessary methodological steps to be taken for the adaptation of the EC-PC to the family caregiver was found. Therefore, the aim of this study is to present a detailed description of the methodological process of adapting the EC-PC to the family caregiver (EC-PC-Family), providing transparency to the process followed to construct a robust instrument, to contribute towards filling the gap found in the scientific literature. https://doi.org/10.3390/nursrep14010041 March 2024 Long Term Conditions Change in treatment burden among people with multimorbidity: a follow-up survey Hounkpatin HO, Roderick P, Harris S, Morris JE, Smith D, Walsh B, Roberts HC, Dambha-Miller H, Tan QY, Watson F, Fraser SD Background: Treatment burden is the effort required of patients to look after their health and the impact this has on their functioning and wellbeing. Little is known about change in treatment burden over time for people with multimorbidity. Aim: To quantify change in treatment burden, determine factors associated with this change, and evaluate a revised single-item measure for high treatment burden in older adults with multimorbidity. https://doi.org/10.3399/bjgp.2022.0103 October 2022 Long Term Conditions Person-centred integrated care for people living with Parkinson's, Huntington's and Multiple Sclerosis: A systematic review Bartolomeu Pires S, Kunke Dl, Kipps C, Goodwin N, Portillo MC People living with long-term neurological conditions (LTNCs) have complex needs that demand intensive care coordination between sectors. This review aimed to establish if integrated care improves outcomes for people, and what characterises successful interventions. https://doi.org/10.1111/hex.13948 January 2024 Long Term Conditions Psychometric properties of the living with long term conditions scale in an English-speaking population living with long term conditions in the UK Ambrosio L, Hislop-Lennie K, Serrano-Fuentes N, Driessens C, Portillo MC Objective: To present the psychometric properties of the living with long-term condition (LwLTCs) scale in an English-speaking population of people with different LTCs. Design: An observational and cross-sectional study, with retest was conducted. Psychometric properties including feasibility, internal consistency, confirmatory factor analysis, reproducibility and content validity were tested. https://doi.org/10.1136/bmjopen-2023-077978 January 2024 Long Term Conditions Exploring Adherence to Pelvic Floor Muscle Training in Women Using Mobile Apps: Scoping Review Harper RC, Sheppard S, Stewart C, Clark CJ Pelvic floor dysfunction is a public health issue, with 1 in 3 women experiencing symptoms at some point in their lifetime. The gold standard of treatment for pelvic floor dysfunction is supervised pelvic floor muscle training (PFMT); however, adherence to PFMT in women is poor. Mobile apps are increasingly being used in the National Health Service to enable equity in the distribution of health care and increase accessibility to services. However, it is unclear how PFMT mobile apps influence PFMT adherence in women. We aimed to identify which behavior change techniques (BCTs) have been used in PFMT mobile apps, to distinguish the core "capability, opportunity, and motivation" (COM) behaviors targeted by the BCTs used in PFMT mobile apps, and to compare the levels of PFMT adherence in women between those using PFMT mobile apps and those receiving usual care. https://doi.org/10.2196/45947 December 2023 Long Term Conditions English Validation of the Living with Long Term conditions scale Ambrosio L, Hislop-Lennie K, Serrano-Fuentes N, Driessens C, Portillo MC Background: The English version of the living with long term conditions (LwLTCs) scale is a comprehensive person-centred measure that evaluates the complex process of living with long term conditions. Objectives: To present the psychometric properties of the LwLTCs scale in an English-speaking population in people with different long term conditions. https://doi.org/10.1093/eurpub/ckad160.811 October 2023 Long Term Conditions Reducing the impact of COVID-19 on physical activity and mental health Ambrosio L, Faulkner J, Lambrick D, Morris J, Compton E, Portillo MC Background: During the COVID-19 pandemic the United Kingdom government released regular guidance on limiting the spread of COVID-19. People, including those with long term conditions, were told to use physical distancing, self-isolation and/or shielding during COVID-19 to protect themselves and others. A consequence of these interventions was to exacerbate poor lifestyle behaviours, namely less physical activity. Objectives: To propose recommendations to support and sustain their physical activity of people with long term conditions during and after COVID-19 or other pandemics. https://doi.org/10.1093/eurpub/ckad160.1570 October 2023 Long Term Conditions A conceptual framework for characterising lifecourse determinants of multiple long-term condition multimorbidity Stannard S, Berrington A, Paranjothy S, Owen R, Fraser S, Hoyle R et al Social, biological and environmental factors in early-life, defined as the period from preconception until age 18, play a role in shaping the risk of multiple long-term condition multimorbidity. However, there is a need to conceptualise these early-life factors, how they relate to each other, and provide conceptual framing for future research on aetiology and modelling prevention scenarios of multimorbidity. We develop a conceptual framework to characterise the population-level domains of early-life determinants of future multimorbidity. https://doi.org/10.1177/26335565231193951 September 2023 Long Term Conditions Multidisciplinary ecosystem to study lifecourse determinants and prevention of early-onset burdensome multimorbidity (MELD-B) – protocol for a research collaboration Fraser SD, Stannard S, Holland S, Boniface M, Hoyle RB, Wilkinson R et al Most people living with multiple long-term condition multimorbidity (MLTC-M) are under 65 (defined as ‘early onset’). Earlier and greater accrual of long-term conditions (LTCs) may be influenced by the timing and nature of exposure to key risk factors, wider determinants or other LTCs at different life stages. We have established a research collaboration titled ‘MELD-B’ to understand how wider determinants, sentinel conditions (the first LTC in the lifecourse) and LTC accrual sequence affect risk of early-onset, burdensome MLTC-M, and to inform prevention interventions. https://doi.org/10.1177/26335565231204544 September 2023 Long Term Conditions Improving personalised care, through the development of a service evaluation tool to assess, understand and monitor delivery Johnson L, Kirk H, Clark B, Heath S, Royse C, Adams C, Portillo MC Systematically implementing personalised care has far reaching benefits to individuals, communities and health and social care systems. If done well, personalised care can result in better health outcomes and experiences, more efficient use of health services and reduced health inequalities. Despite these known benefits, implementation of personalised care has been slow. Evaluation is an important step towards achieving the ambition of universally delivered personalised care. There are currently few comprehensive assessments or tools that are designed to understand the implementation of personalised care at a service or system level, or the cultural, practical and behavioural factors influencing this. The aim of this paper is to describe the development and testing of a system-wide evaluation tool. https://doi.org/10.1136/bmjoq-2023-002324 September 2023 Long Term Conditions

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.

ADOPTED: SORT-IT (Salisbury Operational Research Track – Improving Together) SORT-IT is an exciting programme of collaborative research exploring how operational research can drive improvements in peri-operative management at a time of significant challenges for the NHS. These include limited resources, increasing demand and workforce fatigue, and urgently require us to think creatively and collaboratively. The wider SORT-IT programme is a joint endeavour led equally by Professor Christine Currie (CC: UoS) and Dr Alexandra Hogan (AH) BA(Hons), PhD, MBBS, FRCA, Consultant Anaesthetist at SHFT / Academic affiliation – UCL Great Ormond Street Institute of Child Health. It is a novel programme of collaborative research with potential for clinical implementation under the SHFT strategic aim of ‘Improving Together’. In this proposal, working with SHFT, we are seeking funding for a seed project to develop the understanding and documentation needed to apply for external funding for the wider programme (target - NIHR RfPB). We will investigate two specific steps along the peri-operative pathway. 1. ‘Booking’ of a patient (processing of the patient’s referral for surgery and setting the course of their perioperative care). 2. Recovery (optimising patient preparation for their step-down from Theatres). SHFT serves approximately 270,000 people, of whom 12,500 underwent elective surgical procedures in 2019/20. Similar to many Trusts post-pandemic, only 70.2% of patients met the referral-to-treatment waiting time target of 18-weeks. The NHS is challenged by rising waiting lists, a trajectory established pre-pandemic (2012-2019) that is now accelerating. Consequently, the Government’s target of 92% of patients achieving ≤ 18-weeks to starting consultant-led treatment has not been met since 2016 (NHS Key Statistics, July 2023).

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

ADOPTED: 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: 30/11/2023 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.

Medicines optimisation Principal Investigator: Dr Simon Fraser Team members: Dr Simon Fraser (Associate Professor of Public Health. School of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital), Professor Chris Edwards (Professor of Rheumatology, Southampton and Associate Director of the NIHR Clinical Research Facility) Dr Chris Holroyd (Consultant Rheumatologist, University Hospital Southampton NHS Foundation Trust), Dr Kinda Ibrahim (Senior Research Fellow, Faculty of Medicine, University Hospital Southampton NHS Foundation Trust), Dr Ravina Barrett (Pharmacist, University of Portsmouth), Dr Clare Howard (Chief Pharmacist, Medicines Optimisation, Wessex AHSN), Dr Mary O’Brien (NHS England, NHS Rightcare), Dr David Culliford (Senior Medical Statistician, Health Sciences, University of Southampton), Professor Paul Roderick (Professor of Public Health, Primary Care and Population Sciences, University of Southampton), Professor James Batchelor (Director Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton), Dr Matthew Stammers (Senior Endoscopy Fellow, University Hospital Southampton and Clinical Informatics Research Fellow at Clinical Informatics Research Unit) Start: 1 October 2019 Ends: 30 September 2024 Project Partners: University Hospital Southampton NHS Foundation Trust, NHS England (NHS Rightcare), University of Portsmouth, University of Southampton, Academic Health Sciences Network (AHSN) Wessex. Lay summary Painful conditions associated with age (such as arthritis) are common in the UK and safe pain relief options for older people are limited. Anti-inflammatory drugs such as ibuprofen are widely used – both bought from the pharmacy and prescribed by doctors, but they have significant risks, such as bleeding from the stomach and kidney damage. Older people and those with certain long-term medical conditions are at higher risk of experiencing bad effects from these drugs. Another issue concerns people who are taking one of a group of medications call ‘disease-modifying anti-rheumatic drugs’ (DMARDs). These drugs are often used for rheumatoid arthritis and work by slowing its progression, reducing the likelihood of severe joint damage and other related health problems. They are also used for inflammatory bowel diseases, such as Crohn’s disease. Methotrexate is one of the most commonly used DMARD in arthritis and azathioprine is one of the most commonly used in inflammatory bowel disease. Anti-TNF drugs are an important group of so called ‘biological agents’ – another type of DMARD. DMARDs are powerful drugs that require regular blood tests to check for adverse effects, such as liver problems, and guidelines advise how often these tests should be done. However, for most people, these blood tests are almost never abnormal, and could potentially be safely done less frequently. In addition, some people with inflammatory arthritis have an excellent response to DMARDs. Stopping DMARDs can lead to flare ups of disease, but the amount of therapy used may be tapered successfully to reduce dose-dependent adverse events and costs. In one part of this research we will use an anonymous database of about half a million people from GP practices in Hampshire to identify how many people are prescribed anti-inflammatory drugs, particularly those who may be at high risk of complications by being older or having other conditions. The aim is to help doctors transfer high risk patients to other pain relief options. In another part, we will use the same dataset and also data from people who have attended University Hospital Southampton NHS Foundation Trust who take methotrexate, azathioprine and anti-TNF drugs. We will look at their blood results to see if some people might not need blood tests so frequently. Patients may be understandably nervous that problems could be missed if the blood check is not done so often, so we plan future research asking patients and doctors whether such reduction in checks would be acceptable. We will also investigate the possibility of successful dose reduction strategies for anti-TNF drugs. Specifically, we will identify which kinds of patients tend to succeed in being able to reduce the dose. This research has potential to reduce the burden on patients and on the NHS by reducing the frequency of blood tests and/or medication burden for some people and avoiding hospital admissions for anti-inflammatory drug complications. Through connections our team has already, the results of this research will be shared with relevant doctors, nurses and patient groups across Wessex so it makes a difference locally. It will also be published in academic journals and presented at conferences. Publications: Characterising risk of non-steroidal anti-inflammatory drug-related acute kidney injury: a retrospective cohort study

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.