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Social Prescribing Link Workers framework: supporting complex needs of adults living with physical and mental health long term conditions Chief Investigators: Dr Leire Ambrosio. Lecturer. School of Health Sciences, University of Southampton and Mari Carmen Portillo. Professor of Long-term Conditions. School of Health Sciences, University of Southampto. Team: Skaiste Linceviciute. Research Fellow. Faculty of Medicine, University of Southampton, David Baldwin. Professor of Psychiatry and Section Head, Clinical Neuroscience, Faculty of Medicine, University of Southampton Joseph Jenness. Senior Manager at Southampton Voluntary Services. SO:Linked Jade Topham. Social Prescribing Link Worker, Southampton North PCN William Barnaby Jones. NIHR ARC Wessex PPIE, University of Southampton Traci Carroll. PPIE Representative as part of the NIHR ARC Wessex PPIE group, University of Southampton Siân Brand. Chair of Social Prescribing Network, Social Prescribing Network Partners: Hampshire and Isle of Wight Integrated Care Board, Hampshire and Isle of Wight NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust, University of Southampton, Anxiety UK, Social Prescribing Network, SO: Linked. Start: 1 October 2024 End: 31 March 2026 Background to the research As part of the NHS Long Term Plan in rolling out an integrated approach built around personalised care, NHS England has initiated the Social Prescribing Link Workers (SPLW) model to offer personalised support for patients in primary care facing continued pressures with long-term conditions, and to bridge fragmented healthcare systems with key community stakeholders through joined-up approaches (NHS, 2019). Our recent SPLW project demonstrated that despite Link Workers’ positive and multifaceted impact, the current efforts lack standardised approach and robust guidance that delay and complicate the work of SPLWs in delivering coordinated support for addressing the needs of adults with long-term physical and mental health conditions. Key challenges related to the lack of collaborative planning, expectations management, and limited communication with multidisciplinary teams. This leaves SPLWs managing complex cases with overstretched workload and with patients struggling to achieve sustainable, long-term support for the management of their physical and mental health LTCs. Aims of the research Informed by the findings of our previous SPLW project, a need has emerged to develop a consistent SPLW framework that sets out sustainable and integrated pathway that can optimise social prescribing services in the community, standardise guidance for training support and is equipped to support the long-term management of complex needs of adults with physical and mental health LTCs.

COMPLETED: How to Support children with cancer, or another serious condition, and their parents during the COVID-19 outbreak How to Support cHildren with cAncer, or another serious condition, and theiR parents during the COVID-19 outbreak?: understanding Experiences, information and support needs, and decision-making – the SHARE study Research team Chief Investigators: Professor Anne-Sophie Darlington- Professor of Child and Family Psychological Health- University of Southampton Dr Bob Philips- Senior Lecturer and Honorary Consultant in Paediatric / Teenage-Young Adult Oncology-The Leeds Teaching Hospital NHS Trust Dr Jess Morgan- Senior Research Fellow & Paediatric Oncology Trainee- University of York Mr Ashley Ball-Gamble- CEO of Children’s Cancer and Leukaemia Group (CCLG)- CCLG Project team members: Dr Nicole Collaço- Research Fellow- University of Southampton Dr Luise Marino- Clinical Academic Paediatric Dietitian- University Hospital Southampton Dr Arvind Nagra- Paediatric Nephrologist- University Hospital Southampton PPI group Organisations involved: University of York, Children’s Cancer and Leukaemia Group, University of Southampton, University Hospital Southampton, The Leeds Teaching Hospital NHS Trust, Kidney Research UK, Kidney Care UK, British Heart Foundation, Children’s Heart Foundation ,Cystic Fibrosis Trust, Together for Short Lives, The Martin House Research Centre, Harry’s Hat, Shine. Summary Children and young people with cancer may be particularly vulnerable. Those undergoing treatment have a weakened immune system, meaning they will find it more difficult to fight infections. [1] Comprehensive advice for parents has been compiled by experts and disseminated through the UKs Children’s Cancer and Leukaemia Group (CCLG).[1] However, we urgently need to increase our understanding of evolving experiences, information needs and decision-making of these families under these extraordinarily stressful circumstances. Only through investigating parents’/main carers’ experiences and needs will we be able to tailor and provide the right support, in terms of guidance, information updates, and online interventions to reduce distress and anxiety. What did we find out? We found that the impact of COVID-19 on different populations shared some common experiences: Disruption to healthcare services- all populations faced challenges due to disruptions in healthcare services which affected access to necessary medical care and treatments Increased anxiety and stress- COVID-19 brought about increased anxiety and stress levels in all populations, particularly amongst caregivers who had specific concerns about their child’s health and safety Limited social interactions- the pandemic led to limited social interactions for all populations, resulting in feelings of isolation and loneliness Social support networks: families in general faced amplified challenges due to limited social support networks, emphasizing the importance of community resources in managing the pandemic’s effects. Reassurance gained that certain populations may not be at significantly higher risk of adverse outcomes or psychological distress. Findings emphasised the need for tailored support services, clear communication, education and psychological support to address challenges faced by these populations during the COVID-19 pandemic. What difference will this make? Insights provided valuable information for healthcare providers and relevant charities organisations to make informed decisions about how to support people and allocate resources effectively. In addition the information can be used to develop targeted strategies and interventions that address the specific challenges faced by different populations such as disruption to healthcare services, increased anxiety and stress and limited social interactions. By understanding the impact of COVID-19 on various populations, policies can be developed to address the specific needs and concerns of different groups. Findings emphasised the importance of prioritising clear communication, education and psychological support to ensure the wellbeing of these populations. Why is this important for patients, health and care providers and policy makers? Patient care: understanding the impact of COVID-19 on different populations helps healthcare providers tailor their services to meet specific needs; including ensuring access to healthcare services, managing increased anxiety and stress and providing psychological support. Health & Care Providers: the findings provide valuable insights for healthcare providers to address the challenges faced by different populations. This includes adapting healthcare services, clear communication and providing education to effectively support patients. Policymakers: Knowledge of the impact of COVID-19 on various population helps policymakers make informed decisions, including allocating resources, developing tailored support services, and implementing policies to address the specific needs of different populations. Research outputs: COVID-19: experiences of lockdown and support needs in children and young adults with kidney conditions Yincent Tse, Anne-Sophie E. Darlington, Kay Tyerman, Dean Wallace, Tanya Pankhurst, Sofia Chantziara, David Culliford, Alejandra Recio-Saucedo & Arvind Nagra COVID‐19 and children with cancer: Parents’ experiences, anxieties and support needs Anne‐Sophie E. Darlington, Jessica E. Morgan, Richard Wagland, Samantha C. Sodergren, David Culliford, Ashley Gamble, Bob Phillips https://onlinelibrary.wiley.com/doi/full/10.1002/pbc.28790 https://journals.sagepub.com/doi/full/10.1177/21501351211007102 https://link.springer.com/article/10.1007/s00467-021-05041-8 https://onlinelibrary.wiley.com/doi/full/10.1002/ppul.25537 https://onlinelibrary.wiley.com/doi/pdf/10.1111/apa.16229 https://link.springer.com/article/10.1007/s00381-023-05980-7 https://adc.bmj.com/content/108/3/198.abstract https://www.thesun.co.uk/news/11968084/coronation-street-mitochondrial-disease/ https://www.togetherforshortlives.org.uk/forgotten-families-families-feel-more-isolated-than-ever-under-lockdown/ https://www.southampton.ac.uk/news/2021/04/share-study-results.page https://www.ncri.org.uk/areas-of-interest/cancer-covid-19/ 11-share-study | Institute for Life Sciences | University of Southampton Life Sciences Annual Reports | Institute for Life Sciences | University of Southampton Conferences/presentations: SIOP (International Society of Pediatric Oncology)- E-poster discussion (2021) Royal College of pediatrics and child health- poster presentation (2021) 53rd ESPN Annual Meeting- oral presentation (2021) 7th King John Price pediatric respiratory conference- poster presentation (2021) Webinar- Nutricia- What's next for improving nutrition & growth outcomes in infants with congenital heart disease? (2021) Webinar- University of Surrey: Impact of Covid-19 on families: a focus on new parents, children, and people with learning disabilities, with reflections from professional practice (2021) Webinar: Pediatric Oncology Educational meetings (2021) Webinar: European Paediatric Psychology Network (EPPN) – background and mission (2020)

ADOPTED PROJECT: Understanding risk stratification of patients with chronic kidney disease (CKD) in primary care ADOPTED PROJECT: Understanding risk stratification of patients with chronic kidney disease (CKD) in primary care Principal Investigators: Professor Hazel Everitt , Head of the Primary Care Research Centre, Deputy Head of the School of Primary Care, Population Sciences and Medical Education at Southampton University and Deputy Academic Capacity Development Lead for the NIHR School of Primary Care Research. Dr Kristin Veighey , Academic Clinical Fellow in General Practice, and Honorary Senior Clinical Lecturer, University of Southampton. Co-Associate Director of the Southampton Academy of Research (SoAR). Team: Dr Simon Fraser Associate Professor of Public Health, and Consultant in Public Health Dr Kinda Ibrahim, is an Academic Pharmacist and Senior Lecturer within the Primary Care Research Centre at the University of Southampton. She is the deputy lead for the NIHR Applied Research Collaboration (ARC) Wessex Ageing and Dementia Theme and the Associate Director for career development Dr Emma Teasdale Research Psychologist and Qualitative Research Fellow in Primary Care Dr Michelle Myall, is a Senior Research and Implementation Fellow at NIHR Applied Research Collaboration (ARC) Wessex Kate Henegan-Sykes (co-applicant) is a member of the Primary Care Patient and Public Involvement and Engagement (PPIE) group Charles Pickering (collaborator) is a patient with chronic kidney disease. Starts: 01/12/2023 Ends: 30/11/2025 Funded by: NIHR School for Primary Care Research The kidneys are 2 small fist sized organs which sit in the back. Kidneys clean the blood. They take away extra water and waste and turn it into urine or ‘wee’. Chronic kidney disease (CKD) is a long-term condition. In CKD, the kidneys do not work as well. More than 1.8 million people in England are known to have CKD. It is thought there may be 1 million more who have not yet been diagnosed. This is because early CKD has no symptoms. So it's important to test for CKD in people who might have it. This includes people with diabetes, high blood pressure, and a family history of CKD. People with CKD are more likely to have, and die from, heart attacks and strokes. For a small group of people their CKD will get worse over time. This could mean that they need ‘renal replacement therapy’ (RRT). This is where a machine (dialysis) or a kidney transplant (someone else’s kidney put into them in an operation) does the job of the failed kidneys. This allows the person to survive. These treatments are very expensive. Along with transport to treatment centres they cost the NHS around £780m every year. Having CKD can also reduce a person’s quality of life. People who have, or might have, CKD should have the protein in their urine measured. This is a good way to see if kidneys are damaged. It can be used along with a blood test result to work out a ‘risk score’. This score can help to show which people are at most risk of their CKD getting worse. This means that they can be offered medicines and told about possible changes to their lifestyle and diet that might help reduce their risk. The score can also be used to reassure people who have a low risk. We want to understand why working out a person’s risk of CKD is not always done in general practice (GP) surgeries. To do this, we will first interview 20-30 GPs and practice nurses. These are the people who would do the risk scores for patients. They will come from GP practices across Wessex and Leeds. We will then hold 4-5 focus groups with GP practice teams, including GPs and nurses, but also pharmacists, practice managers, and reception/administration staff. We will ask them about how procedures could be improved to make sure CKD patients have their risk measured. This information will help us to work out how to improve the way that we measure risk in CKD.We will then plan a second study to test a new process. This new process will be developed from what we find out in this study.

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

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

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.

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

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.

COMPLETED: WADE. Women and Desistence Engagement : An evaluation of a community-based, conditional caution pilot programme for women in the criminal justice system Principle Investigator: Sara Morgan, Fiona Maxwell Start Date: 20th November 2019 End Date: 30th March 2022 Background and study aims Compared to the previous year, in 2018 there was an overall 8% increase in theft in England and Wales and a 6% increase in crimes involving sharp instruments or knives. In order to tackle this increase in crime, many believe that more needs to be done to address the reasons why people commit crime in the first place, as well as the damage it causes to peoples’ lives. This means working together in the community to offer solutions to those affected by crime, including victims and offenders. When we discussed possible solutions with local service providers, it was felt that a tailored approach is needed for women, as their needs are unique. Women in prison are very likely to be both victims and offenders whilst, in the general population, one in four women are also victims of abuse within the home and more than half the women in prison have experienced domestic abuse themselves. In response, three projects are being piloted in Hampshire and Dorset to address the needs of women affected by crime. What does the study involve? To understand how these projects are working, we carried out group interviews with those delivering the pilot intervention projects in the community. These were primarily to understand how the projects are working. We also used information gathered from the project staff about the women using the service to understand whether women go on to seek further assistance in the community, what sort of women engage with the project, and what changes for them as a result of using the service. This study proposal was developed in collaboration with public representatives; including offenders, victims, social care workers, domestic abuse service manager, and police officers. They have all shaped the design of the study; by informing us what types of research questions we should be asking. We continued to involve similar representatives throughout the research study; for example, to co-produce the materials used in the study, such as information sheets, and to gain feedback on the write up of the study. What will we do with the study findings? It is important that the information gained from the study reaches the widest number of people. We therefore considered who to engage, and how to reach them, from the very start of the study. The main findings will be developed into a short summary report, which will be accessible to the general public through our public representatives and collaborators. They might include charitable organisations in the community (e.g. Stop Domestic Abuse, Hampton Trust) or services that work directly with women affected by crime (e.g. NHS, probation services). Impact of the COVID-19 Pandemic The first WaDE cautions were offered from March 2019 and workshops began shortly after. Numbers were initially fewer than expected, and although some variance throughout the year would not have been unusual, there were fewer than the anticipated 10 per month for the first months of the pilot. Unfortunately, from March 2020 the COVID pandemic and stay-at-home regulations had a very significant impact on the operation of the pilot. The pilot was suspended from March as Hampshire Constabulary temporarily ceased offering conditional cautions. From March it was also not possible to deliver the WaDE programme in its intended group format, and a small number of participants who had completed the first workshop as a group completed their second part by telephone on a 1:1 basis with a HT facilitator. As an alternative, a non-mandatory, individual telephone intervention was briefly offered from March 2020 during the first period of restrictions. Overall this had an impact on the planned evaluation, resulting in a reduction in the available quantitative data for analysis (due to fewer numbers coming through the programme). Additionally, there was a planned qualitative element to the evaluation (focus groups) which were cancelled due to the restrictions. Due to the impact of COVID-19 on both the programme operation, and the staff involved in researching, the findings of the final report cover the period of September 2021 – March 2020. Reoffending Due to the suspension of the WaDE programme and the extended period between cohort A completing their workshops and the compilation of this report, reoffending data up to 12m post-intervention is now available. From the initial 27 referrals, 4 women went on to commit further offences. These were: 1 at 35 days (common assault) 1 at 157 days (shoplifting) 1 at 229 days (bladed implement) 1 at 310 days (cannabis) Two of those who reoffended had breached (not attended) any WaDE workshops, and two had completed. A chi-square comparison of the reoffending rate between those who breached and those who attended gives a χ2 value of 2.1, indicating that this difference does not meet the threshold for statistical significance. Exit Questionnaires Hampton Trust routinely ask participants in their programmes to complete an exit questionnaire, which allows for some feedback on the perceived benefits of having attended. It also provides the opportunity for some free text comments. Ten participants answered the following questions: Q1 Since being on the workshops have you identified areas of your life in which you need support? Q2 Since being on the workshop do you have a better understanding of what led you to offend? Q3 Have the workshops helped give you tools/support to make safer more positive life choices? Q4 Since being on the workshops have you accessed other services (e.g. counselling, drugs and alcohol support) or plan to do so in the near future? Q5 Do you intend to attend all or any of the follow-on 12 week programme workshops? Q6 How much have you enjoyed the WaDE workshop? Q7 In your opinion, how well presented were the workshops? Q8 To what extent have the workshops helped you with your problems? Q9 Where 10 is ‘very confident’, how confident are you of not offending in future? On the basis of these responses, the WaDE programme is evidently acceptable to, and valued, by the participants. One respondent was generally negative in her responses and indicated in the free text feedback that she felt she shouldn’t have been having to attend WaDE at all; however even she felt that the course was well presented and enjoyable. Due to the small number of responses and the limited amount of free text feedback, full thematic analysis of the responses is not likely to offer reliable identification of consistent key themes. However, for the majority of respondents the comments reflected overall high levels of satisfaction with the programme, its delivery and its usefulness in terms of helping the participants to understand and address the factors and circumstances leading to their caution. Limitations Overall The WaDE programme delivery, and consequently the size and scope of this evaluation, has been significantly impacted by the COVID-19 pandemic. Greater numbers would have added validity to our findings and allowed for meaningful associations to be explored, while qualitative research would have added a depth of understanding of the true impact of the WaDE programme on its participants. At the time of writing it is hoped that WaDE can now revert to its original model and that a steady throughput in line with original expectations on numbers will be observed. Further research is recommended, including a comparative statistical analysis with a larger cohort. Qualitative research would also be valuable to explore in-depth attitudes, towards reoffending for example, in order to provide better evidence for future decision-making. Conclusions Despite some very challenging times, the team delivering WaDE remains committed to its ongoing operation. Continuing support from the OPCC and a strong working partnership between Hampton Trust and Hampshire Constabulary has enabled the programme to ‘weather the storm’ of the pandemic and emerge ready to re-start. The flexibility and hard work of each individual throughout this time speaks to their belief in WaDE as a worthwhile and much-valued means of supporting female offenders towards a better future.

CHAMPION: Children whose mothers are involved in the criminal justice system in Dorset & Hampshire: developing health and social care outcome indicators Chief Investigator Professor Julie Parkes Professor in Public Health Head of School of Primary Care, Population Sciences and Medical Education Faculty of Medicine University of Southampton, South Academic Block, Southampton General Hospital, Tremona Road, Dr Emma Plugge Associate Professor in Public Health School of Primary Care, Population Sciences and Medical Education Faculty of Medicine University of Southampton, Co-Investigators Dr Donna Arrondelle , Research Fellow, University of Southampton Dr Naomi Gadian, Public Health Specialist Registrar, University of Southampton Donna Gipson, Director EP:IC Consultants Ltd, West Malling, Kent Dr James Hall , Associate Professor of Educational Psychology, University of Southampton Paula Harriott , Head of Prison Engagement, Prison Reform Trust Professor Kathleen Kendall , Professorial Fellow of Sociology as Applied to Medicine, University of Southampton Dr Sara Morgan , Associate Professor in Public Health, Faculty of Medicine, University of Southampton Professor James Raftery , Faculty of Medicine, University of Southampton, Dr Lucy Wainwright , Director of Research, EP:IC Consultants Ltd, West Malling, Kent Starts: 1st April 2023 Ends: 30th September 2024 Summary In this study, we will identify important features of children’s health and wellbeing that are affected when their mother is sent to prison. For example, it might be their mental wellbeing or their behaviour. If we know what the important features are, then researchers and organisations providing services (such as the NHS) can monitor these for change; this is important to see how the child is but also to see if services are helping him or her. In the past, researchers have not looked in depth at the health and wellbeing of these children. We want to look at all the studies conducted so far to see what areas of their health have been looked at and also to find out areas of their health where the evidence is lacking. We will also speak with adults who were children when their mother was imprisoned to hear their views about what health issues are important and what would have helped them at that time. We will also speak to children who are living with their mother in a prison alternative in the community to find out from them about their health and what has helped them in this particular place. Finally, we will speak with a range of professionals, from doctors to teachers, who work with children whose mother has been imprisoned. We will ask them to tell us about the aspects of these children’s health and wellbeing that they think are important and likely to be affected by the child’s mother going to prison. When we have the information from published studies, from the children themselves and from the professionals, we will bring together a group of people with experience of their mother being imprisoned and also professionals. We will work with them to agree the most important features of children’s health and wellbeing that are affected when their mother is sent to prison. These ‘outcome measures’ are helpful to developing services for these children. People with experience of their mother being imprisoned have helped design the project. They will also be important in spreading the word about the study. This will enable us to reach not just academic audiences and policy makers through publishing in journals or presenting at research conferences, but also people with lived experience and charities that work in this area. Informing a wide range of people will be important in ensuring that the findings from this study are acted on.

Improving support for self-management (WASP) Using the Wessex Activation and Self-Management and Personalisation (WASP) Tool to design and implement system wide improvements in self-management support for people with long-term conditions Principal Investigator: Professor Mari-Carmen Portillo Team members: Professor Mari-Carmen Portillo (Professor of Long-Term Conditions, School of Health Sciences, University of Southampton), Dr Hayden Kirk (Consultant Physiotherapist & Clinical Director Adults Southampton, Solent NHS Trust), Dr Chris Allen (Lecturer, School of Health Sciences, University of Southampton), Stephanie Heath (WASP Clinical Lead, Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust), Dr David Culliford (Senior Medical Statistician, School of Health Sciences, University of Southampton), Dr Louise Johnson (WASP Project Manager, Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust), Dr David Kryl (Director, Centre for Implementation Science, University of Southampton), Professor Alison Richardson (Professor of Cancer Nursing and End of Life Care, University of Southampton) Start: 1 October 2019 Ends: 30 September 2024 Project Partners: Solent NHS Trust, Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust, Hampshire and Isle of Wight ICS Lay summary The NHS wants to achieve better health outcomes, improved experience for patients, and more effective use of services and resources for people living with a long-term health condition. Helping people to self-manage their condition helps improve people’s health and their experience of managing the condition in everyday life. Increasing people’s knowledge, skills and confidence may help them to be more actively involved in self-management of their condition. This is sometimes referred to as ‘patient activation’. The Wessex Activation Self-Management Programme (WASP) Self-Assessment Tool has been developed to help health teams understand where their service could do more to help people be more active in the management of their condition. The tool can be used by people who use services and people who plan, manage and deliver care and services. It asks about behaviour – WHAT people actually do, and WHY they do (or don’t do) certain things. The answers can help health teams decide how to improve their service. We have already tested the tool in several different services. Early findings show differences across health services. For example, managers reported ways in which their services helped people to be more active in the management of their condition, but frontline staff (such as nurses and doctors) and patients themselves often had different experiences of this. The next stage is to use the tool to help teams identify aspects of support in their service that require improvement and help services to make these improvements. We will do this by: Assessing the services current practice in relation to self-management support, using the Wessex Self-Assessment Tool. Providing bespoke coaching and support (over a 10-month period) to enable teams (consisting of those who fund the service, managers, frontline staff (such as doctors, nurses and physiotherapists- those who deal directly with patient) and patients themselves) to identify areas for improvement and support them to make improvements that benefit patients. Re-assessing self-management support by repeating the WASP Self-Assessment Tool. Several ways will be used together to decide if this works, how it works and how it can be improved. These will help us understand if this coaching and support can benefit other health services. Firstly, members of healthcare team (including those who provide funding for the service, the services managers, front line staff and patients themselves) will complete a questionnaire. At the end of the study, following the teams coaching and support, this questionnaire will be completed again by all members of the team and the answers will be compared with those provided at the beginning to see if improvements have been made. We expect 8 teams to take part in this. In addition, a small number of teams will be observed during the coaching and support sessions and will be given the opportunity to share their experiences of the service in an interview at the start of the project, as well as of the coaching and support that they have received during an interview at the end of the project. This will help us understand how the coaching and support works and how it can be improved upon. We expect to work with 3 of the 8 teams in this part of the project. Now there's a series of FREE webinars to develop skills supporting personalised care, for health and care professionals in the Isle of Wight, Hampshire. More here

ADOPTED: Gambling in the UK: An analysis of data from individuals seeking treatment at the NHS Southern Gambling Service Principal Investigator: Professor Sam Chamberlain, Professor of Psychiatry at University of Soutampton & Honorary Consultant Psychiatrist at Southern Health NHS Foundation Trust. Co-investigators: Professor David Baldwin, University of Southampton, Professor Jon Grant , University of Chicago, Dr Konstantinos Ioannidis, Southern Health NHS Foundation Trust, Dr Mat King, Southern Health NHS Foundation Trust. Partners : University of Southampton & Southern Health NHS Foundation Trust Summary Gambling disorder is a growing problem amongst adult gamblers. Although previous research has identified some of the harms associated with gambling, few studies have documented how these harms in a large, UK clinical sample. Furthermore, little is known regarding the evolution of factors that predict treatment success dropout or relapse and how individual vulnerabilities interact with environmental risk. This research aims to fill this gap, by analysing a large existing dataset of treatment seeking gamblers. The service has a purpose to provide clinical excellence, while adopting innovative methods (digital pre-assessment, digital monitoring, virtual individual and group therapies etc.) in the clinical setting and to spearhead cutting-edge research which will inform and enhance clinical practice locally, nationally, and globally. The long-term goal of the service is to establish a world-renowned centre that minimises gambling harms through comprehensive evidence-based treatments, research, outreach, and prevention (including early interventions). The clinical focus of the Southern Gambling Service (SGS) is on minimising gambling harms, which involves treating disordered gambling using evidence-based approaches, as well as providing support aimed to promote or replenish recovery capital in individuals (e.g. detecting comorbidities and signposting individuals to other sources of support, enhance social connectedness, promote liaison with sources of financial, social and wellbeing support, setting out the scaffolding of follow up arrangements).