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Impact Since ARC Wessex began in October 2019 it has focussed on the tackling the health and care challenges of our communities and beyond. In addition to our four research themes, ARC Wessex has developed a Mental Health Hub and secured funding to look at the challenges and needs of our social care systems. We also lead on the National efforts to increase the number of researchers working on dementia (DEM-COM ) and the Healthy Ageing, Dementia and Frailty National Priority Programme with collaborated with the ARC network across England. Here we show examples of the impact of our completed research and the benefits to patients and the wider communities in Wessex. Improving physical activity and lives in care homes The ImPACT study looked to create and test the feasibility of using trained exercise volunteers in care home settings to increase the amount of physical activity for older people living there. Are we making the right decisions on nursing numbers? In England a general yardstick is used to work out the number of nursing staff needed to look after patients on a ward in hospital. Recent research has now updated NHS guidance with its findings Online tool for Long Covid support A website to support people living with Long Covid offers a symptom checker, advice on seeking support, and encourages people to talk about their symptoms with professionals, friends and family. Clever help matches care and skills for district nurses The complexity of managing a busy team of district nurses has been made simpler by using computer and mathematical modelling to schedule visits - and the system could go further. Researchers test new ways to help tackle childhood obesity In England, over a fifth of children aged 4–5 years were classed as overweight or obese in 2021/22. A team of ARC Wessex researchers has been testing a way to help families improve kids diets. Building research capacity in Wessex 60 + 10 + £600K Invested We have trained more than 50 health and care professionals to make their first steps into research ... more than 10 PhD students are making their next move in research ..and growing numbers of Post Doctorate researchers getting to grips with the issues that effect us all

Buy-in and Engagement 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 who needs to be engaged as part of the implementation process, what routes to engagement to use and how engagement will be maintained during implementation. 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 “From the start, we decided it was important to use our current networks and involve key people who had established credibility and who were trusted . The commitment and drive for the project by the lead ensured others readily identified its value and were prepared to engage and commit to see the project to realisation. We involved our Communications Team at this early stage and provided regular updates both internally and to partner organisations so that they were aware and felt involved in the project. We continued to recruit key people from partner organisations so that they would spread the message and obtain buy-in within their organisations. Our stakeholder group established a clear plan, including ensuring we considered all governance processes and decisions were actioned. We also identified early on who our ‘anti-champions’ were and discussed how we would manage their resistance or if they attempted to derail implementation. It was a massive team effort that required time and input from all involved. We also confirmed our organisation was fully committed to adoption and this enabled us to show that the intervention was commissioned. This resulted in other organisations having reassurance and confidence to engage and not having to ‘take a risk’ and be the first to sign up. ” Drive Partnership Working Project (DPWP) Take away tips Buy-in and engagement is integral and should be considered at the start and throughout implementation Engagement is necessary at all levels and must be sustained

Web-based Implementation Toolkit (WIT) Quick links: 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 Web-based Implementation Toolkit (WIT) is designed to be easy to use and intended for a variety of users, projects and settings where implementation is planned or being considered. Implementation is the attempt to introduce a new intervention, innovation or policy developed through research and apply it to health and/or social care and the third sector. WIT provides you with an interactive Implementation Wheel, Checklist and bite-size Webinars (average 10 minutes) to support you through your implementation journey. Who is WIT for? WIT recognises the need to provide freely available, accessible and simple to use tools that focus on key considerations at the outset of a project. WIT was through interactive workshops with health and social care professionals, third sector organisation professionals, academics and members of the public. Anyone looking to understand more about or engage in implementation. Why use WIT? When to use WIT 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 implementation Implementation is the attempt to introduce a new intervention, innovation or policy developed through research and apply it to health and/or social care and the third sector. co-produced Co-production refers to a way of working together, often with service users, to reach a collective output. testing From the beginning – when first considering and designing a project Throughout all stages of your implementation journey and beyond To guide you through implementation considerations for your project There are six wheel domains to help you consider what is required for implementation. Click on a domain segment to find out more. How to use WIT Use the interactive Implementation Wheel, Checklist and bitesize Webinars to support you on your implementation journey and beyond. The six Wheel domains can be used iteratively, and in no particular order. The Checklist is downloadable and consists of the same domains as the Wheel. You can use this to complete with your team and check progress of your implementation journey. The Webinars , approximately 10 minutes duration, provide sessions relating to the six Wheel and Checklist domains and also to an introduction to implementation and implementation theories and frameworks. Hover on keywords to see definitions Other words in bold represent key learning points The Resources section provides suggestions for other resources you may find helpful. Feedback via our short survey If you fulfil the criteria on the attached poster , Researchers from the School of Health Sciences, University of Southampton/NIHR ARC Wessex would like you to test WIT by providing feedback via a short survey . Or alternatively scan the QR code. Thank you. Contact us If you have any questions about WIT, please contact: C.F.Brooks@soton.ac.uk Disclaimer The development of WIT has been supported by the NHS Insight Prioritisation Programme (NIPP). The views expressed are those of the authors and not necessarily those of the NHS. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of this website. How to cite Brooks, C.F., Lund, S., Kryl, D., and Myall M. (2023) Web-based Implementation Toolkit (WIT). University of Southampton. Available at: www.arc-wx.nihr.ac.uk/web-implementation-toolkit Accessibility We are committed to providing a website that is accessible to as many people as possible. We are actively working to increase the accessibility and usability of the website.

COMPLETED: GOODNIGHT Covid-19 to care-home-based vulnerable individuals Novel corona virus (COVID-19) is a virus that has spread quickly around the world. Elderly people with other health problems have a high death rate from the infection. There are no treatments for COVID-19 so prevention of infection is very important. COVID-19 is thought to infect people via the nose and mouth. Current best practise to prevent infection focuses on good hand hygiene, the wearing of masks and by limiting social contact. However, elderly people in care homes have to come into contact with staff members who are looking after them. Hypertonic saline nasal irrigation and gargling (HSNIG) has been shown to reduce the viral load of coronaviruses and has potential to reduce Covid-19 transmission in a community setting. The objective of this trial is to assess the feasibility and acceptability of care home staff adopting this technique. This research has now been submitted for publication. If you would like to know more about this study please contact Dr Ryan Buchanan Co-Chief investigators Dr Thomas Daniels, Consultant Respiratory Physician, Honorary Senior Clinical Lecturer, University of Southampton Dr Ryan Buchanan, Academic Clinical Lecturer, Primary Care, Population Science and Medical Education, University of Southampton Partners: University Hospital Southampton NHS Foundation Trust, Southampton CTU & NIHR ARC Wessex Co-applicants Professor Julie Parkes, Professor of Public Health, University of Southampton Professor Helen Roberts, Professor of Medicine for Older People, University of Southampton Emeritus Professor Jeremy Wyatt – University of Southampton Dr Beth Stuart – Medical Statistician, Southampton Clinical Trials Unit Dr Kinda Ibrahim - Senior Research Fellow, Faculty of Medicine, University Hospital Southampton NHS Foundation Trust Dr Andrew Cook – Public Health Consultant, Fellow of Health Technology Assessment, University of Southampton See the training video for Care Home staff: Publications http://dx.doi.org/10.14283/jnhrs.2021.3

COMPLETED: Promoting person-centred care using the CHAT&PLAN conversation guide Promoting person-centred care using the CHAT&PLANTMconversation guide Project leads: Professor Jackie Bridges (Professor of Older People's Care, School of Health Sciences, University of Southampton), Dr Teresa Corbett (Lecturer, Solent University) Team members: Professor Jackie Bridges (Professor of Older People's Care, School of Health Sciences, University of Southampton), Dr Teresa Corbett (Lecturer, Solent University), Professor Alison Richardson (School of Health Sciences, University of Southampton), Dr Jane Winter (Macmillan Consultant Colorectal Nurse, University Hospital Southampton NHS Foundation Trust), Start: 1 October 2019 Ends: 30 April 2022 Project Partners: University Hospital Southampton NHS Foundation Trust, Southern Health NHS Foundation Trust, Bournemouth University, Macmillan Cancer Support Lay summary The aim of this Wessex ARC project is to share a conversation guide we have developed through our research. The guide helps health and social care staff talk to older adults who have lots of different conditions. The guide has 8 steps that should be followed in a meeting with people about their needs and personal goals. We call the guide “CHAT&PLAN” and we’d like to make sure that people working in health and social care know about it and use it in their work. This website leads to resources to support people to use CHAT&PLAN in their work. We have a new project underway with the Wessex Cancer Alliance that tests out some new ways of supporting people with cancer, including the CHAT&PLAN. Corbett, T., Cummings, A., Lee, K., Calman, L., Fenerty, V., Farrington, N., Lewis, L., Young, A., Boddington, H., Wiseman, T., Richardson, A., Foster, C., Bridges, J. (2020). Planning and optimising CHAT&PLAN: a conversation-based intervention to promote person-centred care for older people living with multimorbidity. PLOS One . https://doi.org/10.1371/journal.pone.0240516 The following people were involved in the research behind the CHAT&PLAN: Dr Hilary Boddington, Professor Jackie Bridges, Dr Lynn Calman, Dr Teresa Corbett, Dr Amanda Cummings, Dr Naomi Farrington, Vicky Fenerty, Professor Claire Foster, Dr Kellyn Lee, Lucy Lewis, Professor Alison Richardson, Dr Jane Winter, Professor Theresa Wiseman, Alexandra Young

COMPLETED ADOPTED PROJECT: Geospatial mapping of emergency calls from older adults to ambulance services in the South Central region, with a focus on people living with dementia: a feasibility study. Lead : Dr Carole Fogg, Senior Research Fellow, University of Southampton Team: Dr Dianna Smith, University of Southampton, Professor Bronagh Walsh, University of Southampton. Collaborators: Phil King – Senior Business Analyst, South Central Ambulance Service (SCAS) Vivienne Parsons – Specialist Business Analyst, SCAS Simon Mortimore – Assistant Director of Business Intelligence, SCAS Martina Brown – Research Manager, SCAS (and additional members of the research team – Helen Pocock – Senior Research Paramedic, Chloe Lofthouse-Jones – Education Lead, Patryk Jadzinski – Paramedic/Senior Lecturer) Nic Dunbar – Head of Community First Responder Operations, SCAS (and Operational Leads David Hamer and Jack Ansell) Starts: 13th March 2023 Ends: 31st July 2023 Summary What is the project about? This is a new project that will explore the feasibility of using geospatial techniques to map emergency 999 calls from older adults, including those living with dementia. What is the rationale for this proposal? NHS ambulance services are under intense pressure to deliver timely and safe care. Immediately life-threatening conditions have to be prioritised. Older people with falls and symptoms related to long-term chronic conditions with lower category calls may experience long delays before an ambulance arrives. Such patients often have recurring needs for emergency care due to lack of alternative care pathways or long waits for social care assessments. These patients may also have dementia, putting them at greater risk of clinical deterioration whilst waiting for their needs to be met. Geospatial projects are of particular interest to emergency services, as a single service covers a wide geographical area and a dispersed population. Currently SCAS uses mapping to identify clusters of self-harm, suicide attempts and other trauma incidents. Impacts of geospatial projects in other ambulance services include improving cardiac arrest response times and identifying vulnerable communities during Covid-19. Adults aged ≥65 represent a large proportion of SCAS demand (2022: 17% of 111 calls, 48% (21,200 per month) of 999 calls), with around 14% living with dementia [3]. Better information on the location and outcomes of these calls through applying geospatial techniques can shape service provision to meet population needs, improve patient experience and outcomes, and enable existing resources to be used to best effect. What are we currently doing? Applicant CF is leading a project collaborating with South Central Ambulance Service (SCAS) to systematise recording of dementia on the ambulance electronic patient record. Ambulance staff are now able to record data about dementia in a specific place, and initial analyses show around 70 entries daily across the South Central region (November 2022). Improved recording of dementia in ambulance data provides an opportunity to explore factors associated with service demand related to dementia, such as deprivation, and to inform configuration of emergency and associated services to meet older people’s care needs more generally. These may include attendance by Community First Responders (CFRs) with additional training regarding dementia, or referral to a social care line to organise care for older people. What are the next steps? We propose to explore the feasibility of using geospatial data to map low category calls to older adults (aged ≥65), including a subgroup of those with dementia. Data on older adults in patients with emergency 999 calls will enable understanding of understand areas of greatest need and identify areas of inequality. Geospatial mapping will also highlight areas in which there are high frequencies of calls so that multi-sector appropriately-trained resources may be focussed in particular geographical areas. Initial results can be used to design prospective studies of care models which are informed by, and evaluated using, geospatial data. How will we achieve this? Project Objectives: 1. Test feasibility and methods of data specification, extraction and aggregation from the SCAS data warehouse. 2. Produce geospatial maps representing the extracted data to identify areas of highest demand, or where Commu nity First Responders and specialist frailty cars may be most needed, and with which equipment. 3. Present the data to stakeholders and identify priorities for follow-on research grant(s). Project Methods: We will meet the objectives by: 1. Working with the SCAS Business Intelligence (BI) team to understand and define data items for specification for a combination of geospatial, administrative (interval between call time and attendance, time on scene), sociodemographic and clinical (main reason for call, record of dementia in patient record following attendance) data for low acuity calls (category 3 and 4) for people aged ≥65 over a one year period. 2. Using ArcGIS software to produce new choropleth maps (Lower Super Output Area [LSOA] scale in the SCAS region (Berkshire, Buckinghamshire, Hampshire, and Oxfordshire) of the frequency of 999 calls and ambulance attendances overall and categorised by sub-groups, e.g. patients presenting with falls / with dementia / experiencing a ‘long wait’. Using Office of National Statistics (ONS) and Census data to estimate the proportion of the population of highest risk for frailty and falls (age, ill health, living alone). Holding at least one stakeholder meeting, involving SCAS staff, CFRs, the public, representatives from services providing urgent care to older people in the community (e.g. specialist frailty cars, social care, general practitioners, fire and police services) to share results, identify immediate impacts and agree areas for further research. What did we find out? •Making maps of who uses healthcare services and where they live is a technique previously used by emergency services to understand patterns in ambulance response times and to identify vulnerable communities. The growing older population and increased demand for emergency care presents an opportunity to use these maps to better understand how the level of patient need for ambulance services varies by geographical area, and if there are differences in what happens to patients after they are seen. •Our study involved developing an academic-healthcare collaboration which included people with the relevant skills and abilities to identify the data that was needed, extract and collate it from healthcare data systems, translate it into geographical maps, and then interpret what the maps could tell us about older people’s use of emergency services in the area. We discussed maps which included the way older patients were distributed across the South Central region, the number of calls, response times, falls, dementia cases and hospital conveyance rates. •We found that there are large geographical differences in the number and type of emergency calls and ambulance requirements for older adults, particularly in how many people were then taken to hospital (“conveyance rates”). The geographical distribution of falls and calls to people living with dementia corresponded with patterns of where older people live in the region. Response times varied by location. Stakeholders recommended adding more information on other available services, including community first responders, to help map interpretation, and identified areas to be explored in more detail, particularly in addressing conveyance rate disparities for falls. What did we do with this new Knowledge? We are continuing discussions with stakeholders to see how the methods and results of this initial study can be incorporated into practice and into future research. We will take on board the suggestions from the SCAS staff on how to improve the maps, and include these in our next analyses. We will collate this information and present it to the SCAS Board to see how the methods may be used in practice now, and what further improvements could be made. The publication from the study provides a clear framework and methods so that other organisations providing emergency care and the Integrated Care Boards that they are a part of so that they can also consider these techniques to evaluate their provision of care to older people. What next? We are going to discuss the results in two workshops at the SCAS 2025 Volunteer Conference to see what volunteers think should be done next in using this data to improve emergency care of older people. We are going to share the results with external stakeholders such as those in the healthcare improvement Q Community Special Interest Group on emergency care to seek wider collaboration for further work. We are developing a grant application to NIHR HSDR to further explore potential explanatory factors for the differences in response times and hospital conveyance rates between geographical areas for older people with non-life-threatening calls, which may identify modifiable factors which could improve the care older people receive in these situations.

ADOPTED: Consequences, costs and cost-effectiveness of different workforce configurations in English acute hospitals: a longitudinal retrospective study using routinely collected data Principal Investigator: Professor Peter Griffiths Deputy Principal Investigator: Dr Chiara Dall’Ora Professor Jane Ball Co-investigator – nursing workforce, Dr David Culliford Co-investigator - statistics, Dr Jeremy Jones Co-investigator – health economics, Ms Francesca Lambert Co-investigator – patient and public involvement (lay researcher), Dr Paul Meredith Co-investigator – health informatics, Paul Schmidt Co-investigator – clinical medicine, Talia Emmanuel PhD student, Bruna Rubbo Senior Research Assistant / Research Fellow and Christina Saville Research Fellow Partners: Portsmouth Hospitals University NHS Trust, University of Southampton Started: March 2020 Ends: February 2023 Aim: This study seeks to understand how variation in the size and make-up of care teams on hospital wards in England influences patient outcomes and the costs of care. Background: Research shows that low registered nurse (RN) staffing levels on hospital wards are linked to undesirable outcomes. These include increased poor experiences for patients, an increased risk of dying and, potentially, other outcomes that are bad for patients and increase the cost of care. These include falls, longer stays and unplanned readmissions. For a long time, studies used hospital level averages rather than looking at what happened to individual patients. This uncertainty makes it hard to understand the likely costs and benefits from investing in staff differently. Developments in information technology now make it possible to link nurse staffing levels experienced by individual patients on every day of their stay, to the outcomes experienced by those patients. Our research group was the first to use these new sources of information to explore how the mix of staff in the nursing team affected outcomes and cost of care. We found that each additional hour of RN time per patient reduced the risk of death and shortened their hospital stay. We found that a small reduction in assistant staff, and a small increase in RNs would improve outcomes with no overall increase in costs. Such findings have implications for how hospitals respond to nurse shortages, but the results come from one hospital and use limited costs and outcomes. It is important to see if the conclusions apply more widely. As RNs are in short supply it is also important to better understand how other staff contribute. Design & methods: Our study is in two parts. Study 1 uses information about ward staff and patients' outcomes drawn from hospital electronic systems. We will use anonymous records gathered from all patients and staff in at least 4 NHS Trusts. Using statistical models, we will estimate the impact of RN and assistant staff levels on outcomes. For example, whether the risk of death is lower when more RNs are working on a ward. We will estimate staff costs and also the costs of events such as unplanned readmission or longer hospital stay. We will estimate the cost per 'quality adjusted life year' associated with changes in nurse staffing. Such measures help policy makers to compare the results of investments in health care and put more value on each year where people are expected to be healthy and independent. Study 2 will analyse national data at a whole hospital level to see how the size of other staff groups (e.g. therapy staff and doctors) might influence outcomes. Patient and Public Involvement: Safe staffing in hospitals is an area of public concern. We developed this proposal with this concern in mind, and shaped it through conversations and consultations with patients and members of the public. A member of the public/carer (who is a co-applicant) will facilitate PPI at all stages of the project, with ongoing engagement and sense checking with patients/public to inform analysis, interpretation and presentation of results. Dissemination: Results will be of interest to a diverse audience. We will present findings to national and international conferences and to policy makers, publish in academic journals and present to stakeholders. We will use professional networks and social media to ensure that outputs reach professional, research and public audiences. Background: The NHS is facing significant challenges in recruiting and retaining staff, particularly registered nurses (RNs). Recruiting unregistered staff is often adopted as a solution to the RN shortage; however, our recent research - the first in England to use longitudinal routinely collected data - found a negative effect of low RN staffing levels on mortality with no evidence that high levels of assistant staff could mitigate the increased risk. Our economic modelling suggested that increases in RN skill mix were potentially cost-effective, but these findings derive from a single NHS hospital Trust with limited cost and outcome data. Aims and objectives: This project aims to estimate the consequences, costs and cost effectiveness of variation in the size and composition of the staff on hospital wards in England. We will build on findings from our previous study, where we looked at staffing on wards in a single hospital. In order to provide estimates that are more likely to apply across the NHS, this study will include at least four hospitals and consider a wider range of outcomes and sources of costs, including death within 30 days of admission, adverse events such as infections, length of hospital stay, readmissions and rates of staff sickness. In order to determine if results are likely to be sensitive to staff groups not on ward rosters we will use national routine data to explore the associations with staffing levels of other groups including medical and therapy staff. Methods: Study 1 will be a retrospective longitudinal observational study with routinely collected data on ward and shift level nurse staffing, and patient outcomes. Data will be derived from the E-Roster systems, used by hospitals to record all planned and worked shifts. We will consider all rostered direct care staff. These data will be linked to patient data derived from the hospital patient administration system (PAS); and other clinical systems and databases of adverse events (e.g. datix). Relationships between RN and assistant staffing levels and outcomes will be explored using survival models incorporating mixed effects. We will use the results of these analyses to model the costs and consequences of different staffing configurations and to estimate the incremental cost-effectiveness associated with change. We will estimate cost per Quality Adjusted Life Year gained or lost (QALY), associated with each staffing configuration using the DANQALE approach. Study 2 will be a panel study using routine national workforce data and outcomes (standardised mortality indicators, patient experience) to consider all staff groups including medical and therapy staff at the hospital level. This study will generate hypotheses about staffing for other groups, confirm the independence (or otherwise) of nurse staffing effects and fill a significant gap in international literature about the association between hospital safety and non-nursing staff levels. Timelines for delivery and impact: our study will be undertaken over 30 months and will provide evidence to inform staffing levels and skill mix planning in the NHS, highlighting potential cost savings, and offering improved patient safety and reduced adverse staff outcomes. To ensure impact, we will work with patients, nurses and key policy makers at all stages; we will publish papers and present to academic and professional conferences, as well as writing lay reports and engaging with traditional and social media

DIALOR: DIgitAL cOaching for fRailty (DIALOR) Principle Investigator: Professor Jane Murphy Team members : Dr Euan Sadler , Dr Michele Board , Dr Kat Bradbury , Professor Mike Vassallo , Dr Simone Yule , Dr Dawn-Marie Walker , Crystal Dennis, Matt Sait, Jim McMahon (Patient and Public Involvement Lead) Partners: Bournemouth University, University of Southampton, University Hospitals Dorset NHS Foundation Trust, The Adam Practice, Dorset CCG, Wessex AHSN, Southern Health NHS Foundation Trust Start: 1/4/2022 Ends: 30/9/2024 Bournemouth University web page Lay Summary Frailty is a condition that affects one in ten people over the age of 65. It means people are at higher risk of falls, disability and poorer quality of life. Some may struggle with decreased energy levels, poor appetite, lower strength and having difficulty with household tasks such as shopping and cooking. As the population ages, frailty also impacts on health and social care services because of more GP appointments and increased hospital and care homes admissions. More people own a smartphone with applications (apps) and have access to the internet. This technology can help people to live well by enabling access to person-centred advice and care. It can help share in decision making to meet well-being and health needs and reduce the burden on health and social care systems. However little research has been done, particularly for people with frailty, living at home. Aims This study aims to explore whether a digital approach could be used alongside support from health coaches to help the lifestyle management of frailty (in its early stages). The approach has been used across the NHS in people with long term conditions which we think will transfer to people with frailty. We will work together with people living with frailty, their carers, health coaches and health care professionals (key stakeholders). Design and methods We will do this through two work-packages (WPs) with people from 2 areas in Wessex (Dorset and Hampshire). WP1 will develop and test a new digital approach. It will include interviews with 10 people with frailty and family carers, 20 health care professionals and health coaches. In WP2, we will train health coaches to use the digital approach and measure how well it works in people with frailty. We will collect data including physical activity, eating and drinking, social engagement, quality of life, frailty status, costs of the approach. We will also ask people about their experiences of using it. We aim to recruit 20 people with frailty and their carers, 20 health coaches, 20 health care professionals and commissioners of care services from both areas to do this. This information will help us plan for carrying out a larger study to implement the approach wider across Wessex. We will regularly seek advice from doctors, nurses, commissioners of services during the project. Patient and public involvement (PPI) A group of family carers and health coaches will support the project by membership of a group to support project design, delivery, analysis and reporting and advise on how we share the findings. NOTE: DIALOR was previously known as DONOR and the name changed in consultation with Public contributors Dissemination We aim to share the findings in academic and professional publications, social media, a website, conferences as well as deliver an end of project stakeholder event. Publications DIALOR (DIgitAL cOaching for fRailty): protocol for a single-arm mixed-methods feasibility study of a digital health coaching intervention for older people with frailty in primary care https://doi.org/10.1136/bmjopen-2023-080480

Wessex SNSDE Study (SETT Centre) Project lead: Professor Chris Kipps, University Hospital Southampton NHS Foundation Trust Building analytic capacity to address compound pressure across health and care systems: testing an approach A pilot project scheme will be undertaken to build on workshop output. SETT:Data and AI, will manage and support a small number of operational modelling projects providing appropriate data governance and clinical data extraction to address proposed service improvement and research questions. Each project will be defined as: · A pilot project expected to lead to future research/grant applications · Requiring clinical data extraction to solve an operational issue · Having clinical and academic team members to identify practical and implementable operational solutions to improve patient care Under the leadership of Prof. Chris Kipps, Clinical Director UHS R&D and SETT Centre, a programme of work will be launched to bring together the interested communities and work through a process to test a cooperative way of working to address real world and current problem(s) relevant to UHS and the broader community.

Understanding barriers and enablers of using the Living with Long Term Conditions scale as part of routine care for people from under-served groups living with type 2 diabetes Chief investigator: Dr Leire Ambrosio, Lecturer, School of Health Sciences, University of Southampton. Team: Professor Mari Carmen Portillo, School of Health Sciences, University of Southampton Dr Lindsey Cherry, School of Health Sciences, University of Southampton Dr Kinda lbrahim, Associate Professor, Faculty of Medicine. University of Southampton Dr Michelle Myall, Principle Researcher, School of Health Sciences, University of Southampton Ms Rashmi Kumar, PPI representative Partners: Ha mpshire and Isle of Wight Integrated Care Board, Hampshire and Isle of Wight NHS Foundation Trust, University of Southampton, Diabetes UK, SO:Linked (Southampton Voluntary Services). Start: 1 October 2024 End: 31 March 2026 Why is this research important? In the England over 15 million people are living with at least one long-term conditions (LTC). People from under-served groups, are at greater risk of having one or more than one LTCs. This not only affects a person’s physical health, but other aspects of their lives, such as emotional, cultural, and socio-economic wellbeing. It is key for healthcare professionals, to understand and assess how a person is living with an LTC to provide person-centred care. We recently developed the Living with Long Term Conditions (LwLTCs) scale for English-speaking populations. This is a person-centred questionnaire to evaluate how well a person lives with a long-term condition, to inform care for people based on their individual needs. What is our aim? To better understand the barriers, enablers as well as contextual factors to successfully use the LwLTCs scale within primary care for underserved groups living with LTCs and liaise with healthcare professionals to support and deliver the future implementation study. What do we plan to do? We will explore potential barriers and enablers to using of the LwLTCs scale in routine primary care. We will interview (n=20) people with LTCs from under-served groups and (n=15) healthcare professionals including General Practitioners (GPs), Specialist Nurses, or Podiatrists who support LTCs patients, across Hampshire. We will also identify and engage with key healthcare professionals to guarantee their support through the later implementation process. All this will help us on developing an implementation strategy to test how feasible it is to use the scale in primary care. How have we involved patients and the public? This study has been developed with public and patient involvement (PPI). Our PPI co-applicant is from a Mixed Asian background from Africa with a family history of type 2 diabetes and living in an area of high socio-economic and health care diversity where high numbers of the population have diverse LTCs. He has been living with an LTC, particularly type 2 diabetes for 20 years. He will chair the PPI group (n=4), help to develop patient information, review data collection materials, and validate and disseminate findings. The PPI group will also assist with reaching out to communities engaged less frequently in research. Three meetings will be scheduled with the PPI group. How will we share our findings? We will publish in academic journals, with public contributor involvement and co-authorship. A lay summary of findings will be provided to participants who wish to receive them. Findings will be shared with clinical teams at primary care practices and healthcare decision makers. How long will it take? 18-months, starting the 1st of October 2024. How will we share our findings? We will publish in academic journals, with public contributor involvement and co-authorship. A lay summary of findings will be provided to participants who wish to receive them. Findings will be shared with clinical teams at primary care practices and healthcare decision makers.

Predicting nurse staffing requirements -validation and scoping extension study (PREDICT-NURSE validation and extension) Chief Investigator: Paul Meredith, Senior Research Fellow, University of Southampton Team: Christina Saville, Senior Research Fellow, University of Southampton Chiara Dall’Ora, Associate Professor in Health Workforce, University of Southampton Zlatko Zlatev, Senior Enterprise Fellow, University of Southampton Peter Griffiths, Chair in Health Sciences Research, University of Southampton Ian Dickerson, PPI Representative Tom Weeks - E Systems Implementation Manager Tom.Weeks@porthosp.nhs.uk Sue Wierzbicki - Lead Nurse - Workforce Sue.Wierzbicki@porthosp.nhs.uk Partners: Hampshire and Isle of Wight Integrated Care Board, Hampshire Hospitals NHS Foundation Trust, Portsmouth Hospitals University NHS Trust, Salisbury NHS Foundation Trust. Start: 1 October 2024 End: 30 September 2025 Our aim We aim to show that a computer algorithm we have developed which uses information that is already collected about patients can provide good estimates of the number of nurses needed on hospital wards to provide safe care for the patients. Background information It is important to have enough nurses to care for patients on hospital wards. If there are too few nurses, patients may take longer to recover, suffer complications, or die, and the capacity of the hospital to cope with new admissions is reduced. Also staff well-being is affected by high workloads and there is more staff sickness. Many hospitals use the Safer Nursing Care Tool (SNCT) to help them manage staffing levels. This involves surveying all the patients in a ward perhaps three times a day. Assessing each patient in this way is an extra nursing task and in itself adds to the workload. We have developed a computer algorithm using data from one hospital which can provide similar estimates of nursing staff requirements to SNCT but we need to check that these estimates would keep patients safe if they were followed. What we will do We shall use data collected for a previous study as input to the algorithm to produce estimates of nurse staffing requirements for each ward shift using information which could be known at the time. We will compare actual staffing with the algorithm’s estimate to see if there is a deficit or surplus of staff. For each admission we will examine how these deficits and surpluses relate to patient outcomes. We will compare using the algorithm to set a threshold for safe staffing with using the SNCT estimates as a threshold. Our comparisons will include looking at how good the methods are for wards with higher numbers of under-served groups such as the over 75s, those with learning disabilities and those with mental health conditions. We will measure the effect of staff shortfalls on the number of staff sickness absences. The performance of the algorithm will be checked using data from a second hospital in the database. We shall work with our partners to find out what tools are used to determine nurse and other staffing requirements on a day-to-day basis in community and mental health settings and what data on care requirements and outcomes is electronically recorded. We will discuss with partners what opportunities, potential benefits and practical considerations there are to implementing a predictive tool of staffing requirements. Communicating results We will write an academic paper, produce an article for the Nursing Times, create a poster for display at conferences, and publicise the results on social media. Involving the public We will involve local PPIE group members in evaluating and commenting on the possible uses of a predictive tool to support decisions in the day-to-day management of nurse staffing levels on wards.

COMPLETED: Developing a web resource to support families bereaved during COVID-19 Principal Investigators : Dr Natasha Campling and Dr Michelle Myall Team Members : Dr Natasha Campling (Lecturer & Senior Research Fellow, School of Health Sciences, University of Southampton; Dr Michelle Myall (Senior Research & Implementation Fellow, School of Health Sciences, University of Southampton); Dr Susi Lund (Visiting Research Fellow, School of Health Sciences, University of Southampton); Dr Alison Allam (Patient and Public Representative) Start: 1 January 2021 Finish: 31 December 2022 Project Partners: Winchester Bereavement Support; The Bereavement Centre (Southern CO-OP) Plain English Summary Why is the study needed? The current coronavirus (COVID-19) pandemic has led to increasing numbers of people who have experienced, or are facing, bereavement both in the UK and worldwide. We know that bereavement can seriously affect people’s health. Bereaved people are more likely to experience serious physical and psychological health consequences, such as heart disease and anxiety and depression, particularly in the first year of losing someone close to them. There are some things that can help prevent the health effects caused by grief. For example, being able to see a person receive good end of life care, being prepared for the death of a person, attending the funeral and having the support of family members and friends. During COVID-19 many families and others important to a dying person have not been present during end of life care and death has occurred suddenly. Social distancing restrictions have prevented the support often provided through families and friends coming together. Restrictions applied to funerals have prevented some families being able to attend the funeral of a relative. All of this can make it difficult for people to make sense of what has happened and to look for support to help them with their loss and grief. However, traditional ways of providing bereavement support (face-to-face or by telephone or video) may not be possible because of an increase in demand for support. A family focused online support resource, which considers grief in the context of the family, offers a way of helping people to deal with their bereavement in these unusual times. What did we do and what did we find out? Families, friends and support networks are key to managing bereavement. COVID-19 social restrictions prevented families and friends from being with the dying and participating in usual rituals to honour the dead. This resulted in social disconnection, feelings of guilt, and difficulty in making sense of the death and reconstructing relationships. In response to this context a theoretically informed, co-produced web-resource to facilitate meaning-making, which situates bereavement in the context of family and friends, was developed. We conducted a survey of bereaved people and bereavement professionals to understand how the pandemic had influenced their bereavement experiences and for their views on the key elements of a web-resource. Findings from the survey along with those from a literature review were shared at an online workshop with bereavement professionals to generate agreement on the content and format of the resource. We worked with them and bereaved people to co-produce the resource which was theoretically informed by the Dual Process Model and Family Sense of Coherence. The resource was piloted to gain user feedback which was used to further refine the website. Following these refinements, the website was evaluated via interviews and focus groups with bereaved people and bereavement professionals. Survey respondents reported the pandemic negatively affected bereavement (guilt, isolation, inability to bear witness) but also presented new opportunities to celebrate the deceased and support the bereaved (new funeral rituals, technology, remote contact, social acknowledgement of grief). Sense-making and managing bereavement were helped through information-giving, support networks, and relocating the person within the family context. A web-resource to facilitate collective grief was viewed positively and endorsed. Key content including family activities to stimulate support, information regarding the range of grief experience and dealing with the practicalities, along with other sources of support was agreed by workshop participants to form the basis of the resource. The Families and Friends in Bereavement website is a novel resource which encourages consideration of bereavement in the context of close social networks. It enables grief to be understood and managed within a shared experience by promoting communication and meaning-making.ur evaluation data demonstrates that the Families and Friends in Bereavement website: •Normalises the range of grief experiences ( about grief page) •Gives permission not to have to grieve all the time ( space to pause page, Dual Process Model theoretical underpinning) •Sits well with the nature of grief – can be accessed in small ‘chunks’ (when concentration is limited), dipped into and out over time (as there is no timeline to grief) •Is therapeutic in itself – calming colours / images and supportive, gentle text, encourages reflection What difference will this Knowledge make? •Contribution to understanding experiences and support needs of bereaved people during COVID-19 and beyond •Using theory to explain these experiences and develop a resource to meet the needs of bereaved people. •The resource makes an important difference to the health and wellbeing of bereaved people within the local population and beyond, regionally and nationally. Addresses the gap in existing support for those experiencing non-complex grief. •The website is a useful resource for professionals to signpost people to (something for their toolbox). It offers a useful addition for the current context of tightened / restricted professional resources and bereavement service cuts. Next Steps •Pursue impact funding . •Harness the interest of a charity to host the resource in the longer term. •Continue to develop partnership with the national funeral director trade associations. •Develop collaborative funding proposal for submission to NIHR palliative and end of life care call (Public Health stream) to build on this work. https://familiesandfriendsinbereavement.org.uk/ Publications https://doi.org/10.12688/f1000research.134193.2