This research addresses the mental health of family carers of adults with learning disabilities. We investigated participants' perceptions of their mental health and views on the accessibility and quality of support. The research involved seven work packages which included public involvement, a rapid scoping review of evidence about family carers' mental health and support, an online exhibition, interviews with parent and sibling carers, digital storytelling workshops, key stakeholder discussions and the creation of learning and teaching materials. Caregiving driven by love is often exploited by health and social care services which deny basic support, information and kindness. Enduring struggle for support and worries about the future are often the cause of mental distress. Participants know what supports mental well-being but have little time to look after themselves due to the lack of support. Social services were described as 'hostile' or absent and participants viewed themselves as exhausted by the lack of support, rather than depressed. Medication can help but can be offered without consideration of their caring role or because there are no alternatives. Participants ask for their statutory entitlements for health and social care support to be met with kindness. We delivered: (1) an expansive public engagement model; (2) an innovative and creative participatory approach to generate stories of care; (3) a dissemination strategy to raise awareness of the mental health of family carers and (4) the development of general practitioner resources. We published journal articles, blogs, magazine articles, an online exhibition, films and presented findings at international conferences. Family carers and people with learning disabilities were involved across the study, and in the Study Steering Group. Recruitment was slower than expected. Carers were unable to use care replacement costs because of a lack of alternative care. There were challenges involving marginalised communities. We engaged with fewer respondents through the Exhibition than the planned survey; however, it was important to respond to participants' views. Health and care services often fail to recognise or adjust support for family carers despite provision under the Equality Act. The role of love in caring relationships, the absence of consideration of this in research, and the exploitation of this love by service systems which rely heavily on family carers were highlighted. Provisions in The Care Act and The Equalities Act are not always upheld, family carers struggle to gain support over years and even the 'feeblest' acts of kindness make a difference in health and care delivery. There is a need for policy-makers and practitioners to review and develop robust monitoring of the provision set out in legislation to ensure family carers and people with learning disabilities' entitlements are met. Small acts of kindness on the part of health and social care providers have a big impact on the well-being of family carers. Further exploration of care as a relational activity. The development of ways of monitoring compliance and adherence to legal frameworks. Bringing together the perceptions, views and experiences of people with learning disabilities, siblings and parent carers to generate a comprehensive understanding of the support needs of these groups. An exploration of the mental health experiences of LGBTQI+ family carers and family carers of autistic adults without learning disabilities. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR135080.

Regular severe acute respiratory syndrome coronavirus 2 testing of care home staff was introduced to reduce transmission following significant morbidity, mortality and disruption for residents early in the pandemic. However, evidence was lacking on benefits relative to disadvantages. The VIVALDI-Clinical Trial aimed to investigate whether regular asymptomatic staff testing for severe acute respiratory syndrome coronavirus 2, alongside funding for sick pay and agency backfill, was feasible and effective in reducing severe coronavirus disease discovered in 2019-related outcomes in residents. VIVALDI-Clinical Trial comprised five interlinking work packages. A cluster randomised controlled trial was conducted from January to August 2023. The 'Test to Care' intervention was coproduced with the care sector. Eighty-one residential/nursing homes in England providing care to adults aged ≥ 65 years. Forty-one homes were randomised to intervention and 40 to control. Care homes were randomised 1 : 1 to intervention (twice weekly staff testing, staff sick pay and agency backfill) or control arm (national testing guidance at time of trial). Primary outcome was incidence of coronavirus disease discovered in 2019-related hospital admissions in residents. Health data from routine national data sets were used alongside aggregate data from participating homes. Health economic and modelling analyses evaluated costs and cost-effectiveness of staff testing. Interviews with care home managers explored post-pandemic policies on staff testing, sickness pay and absence. A process evaluation was conducted to understand intervention roll-out. A mixed-study design investigated the impact of coronavirus disease discovered in 2019 outbreaks on care home residents' quality of life. Stakeholder engagement was undertaken to enable the sector to coproduce recommendations for policy-makers. The trial stopped early for futility due to site recruitment and primary outcome incidence being lower than expected. There was no significant difference in resident coronavirus disease discovered in 2019-linked hospital admission incidence between intervention and control arms (incidence rate ratio 1.19, 95% confidence interval 0.55 to 2.58; p = 0.66). The process evaluation found that changing epidemiology, policy and social norms around coronavirus disease discovered in 2019 shaped the uptake and maintenance of testing. Interviews with care home managers suggested most homes no longer test staff, even when symptomatic, and do not pay for sickness absence outside of statutory sick pay. Modelling concluded that regular staff testing, when combined with non-pharmaceutical interventions preventing transmission among residents, is an effective strategy to reduce cases and deaths among care home residents that could also lead to significant cost savings. There was lower-than-expected quality of life for 43 residents from 9 care homes without outbreak and 1 home with recent coronavirus disease discovered in 2019 outbreak, with older residents experiencing greater benefits from social care support. Intervention acceptability was initially high, but waned because of the changing epidemiological, policy and social context. Contextual changes undermined our ability to evaluate the intervention's impact. However, trial set-up was achieved in < 3 months, and we present findings on the feasibility and economic implications of routine testing and impact of disease control measures on residents' quality of life. Costs associated with severe acute respiratory syndrome coronavirus 2 testing including support payments for care home staff and for care homes to fund agency staff backfill were funded by the United Kingdom Health Security Agency. Our approach provides a model for agile interventional studies in care homes. Research training and capacity building for care home staff are important to ensure that future trials can be delivered efficiently in this setting. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR154310.

In England, care homes are the primary providers of long-term care for older adults. The increasing recognition of the importance of social care underscores the importance of collaboration between the National Health Service and care homes. The lack of data sharing among stakeholders limits opportunities for co-ordinated care, service development and research. Identify how to support research, service development and innovation in care homes. Combine existing evidence with care home-generated resident data to create a minimum data set that is relevant and usable for stakeholders, including residents, relatives, practitioners, researchers, regulators and commissioners. The study used a mixed-methods approach, structured into five work packages, supported by patient and public involvement and engagement with residents, carers and staff: Work package 1: Conducted two evidence reviews on outcome measures and factors enhancing research productivity in care homes. Work package 2: Created a trial archive for secondary data analysis. Work package 3: Conducted a scoping review, a realist review and a national survey to define minimum data set content and assess implementation challenges in English care homes. Work package 4: Linked residents' data from National Health Service and social care data sets with data from study care homes, deriving useful minimum data set variables and assessing data quality. Work package 5: Piloted the minimum data set at two points in care homes within three integrated care systems, conducted focus groups and interviews with care home and integrated care system staff. Three national consultations explored how stakeholders use resident information, measure quality of life and minimum data set usefulness. Additionally, subprojects examined data availability in domiciliary settings, staff reasoning when assessing resident well-being and completing research during rapid policy changes. The reviews revealed significant heterogeneity in outcome measurement and questioned the appropriateness of some methods and measures used for care home research. The Virtual International Care Home Trials Archive merged data from 6 United Kingdom randomised controlled trials with 5674 residents across 308 care homes. International minimum data set studies are a valuable resource for international comparative research. The wide range of measures used are mostly clinical with under-representation of measures important to care homes (e.g. quality of life). A national survey of care homes demonstrated the range of information, including clinical measures being routinely collected. The realist review identified motivation, front-line staff monitoring and embedded recording systems as important for minimum data set implementation. The pilot study recruited 996 residents from 45 care homes, with 727 residents' data included in the minimum data set. Residents' digital care records were linked to statutory health and social care data sets, creating a viable minimum data set prototype with metadata as resource. The study provided an evidence-based critique of care home research and a resource for secondary data analysis for future research. It developed a prototype minimum data set linking National Health Service, social care and care home data, demonstrating its importance as a basis for discussions between health and care staff. The COVID-19 pandemic disrupted relationships and recruitment. Governance challenges prevented linking residents' data to general practitioner records. Future research should assess whether the care home minimum data set improves resident outcomes, service delivery, staff experience, cross-sector collaboration, resource use and digital technology implementation. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR127234.

Ethnic disparities in healthcare access and outcomes have been widely reported across different settings. In this scoping review, we aimed to explore whether adults from minority racial and ethnic backgrounds face higher risks of death after presenting with injuries to emergency healthcare services in high-income countries. We searched five electronic databases [Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Cochrane, Scopus and PsycInfo® (American Psychological Association, Washington, DC, USA)] for peer-reviewed studies published between January 2010 and March 2024. We included studies that compared mortality outcomes by race or ethnicity in emergency healthcare settings such as ambulance services, trauma centres and hospital emergency departments in high-income countries. Out of the 1873 articles identified, 32 met the inclusion criteria. Of these, 20 reported higher risk of mortality for ethnic minority patients compared to White patients following injury. Most studies were conducted in the USA with limited representation from other high-income countries such as Canada and Israel. This strong emphasis on USA-based research limits how well the findings apply to other countries with different healthcare systems. A major issue identified across the studies was the inconsistency in how race and ethnicity were recorded and reported. This lack of standardisation makes it difficult to compare results across studies and may hide the true extent of disparities. To better understand and address ethnic disparities in trauma care, future research should adopt consistent and inclusive ethnicity coding to improve data quality and comparability across studies. Studies should be conducted in a wider range of high-income countries and include pre-hospital settings, where disparities may first appear. This will help build a more globally relevant evidence base. Researchers should also take an intersectional approach, examining how ethnicity combines with other social determinants to influence outcomes. In addition to mortality, future studies using longitudinal and mixed-methods designs should explore long-term recovery and access to rehabilitation to gauge the full impact of these health disparities. The review focused solely on mortality outcomes, limiting insight into broader health outcomes such as long-term recovery, quality of life or patient experiences. It also did not explore how ethnicity interacts with other social factors such as gender, income, disability or immigration status. These gaps obscure the full extent of inequalities in emergency care. This review adds to the growing evidence that ethnic minority patients in high-income countries could be at a higher risk of injury-related deaths. However, inconsistent ethnicity coding and a USA-centric evidence base limit the generalisability of findings. To create fairer and more effective emergency care systems, future research must improve data quality, broaden its geographic scope and consider the complex social factors that shape health outcomes. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR132744.

Demand for imaging in England massively outstrips supply in terms of workforce capacity, with well-documented shortages of both radiographers and radiologists. The COVID-19 pandemic exacerbated already stretched services, which have remained 'in crisis'. Three high profile national reports highlighted the urgent need to develop the capacity and capability of the imaging support workforce, yet it is unclear how this vital workforce is utilised. To investigate the development, deployment and contribution of the support workforce to diagnostic imaging activity across England to determine effective models of practice that will support future workforce transformation and re-design. Research question: What models of deployment of the support workforce exist within diagnostic imaging departments and what service, hospital, regional and national factors may encourage or inhibit implementation of these models? The study employed a mixed-methods explanatory research design, comprising six consecutive workstreams spanning 27 months: (Workstream 1) scoping review; (Workstream 2) census of imaging workforce; (Workstream 3) engagement with imaging networks; (Workstream 4) deep dive review of selected trusts; (Workstream 5) qualitative case studies; (Workstream 6) determinant framework. All National Health Service diagnostic imaging (radiology) services and imaging networks located within England were in scope. Participants included imaging network representatives (n = 18), radiology service managers (n = 24), and Imaging Support Workers and Assistant Practitioners, their supervisors and department managers (WS5, n = 113). This was an exploratory observational study. Findings were synthesised to create a determinant framework (Maturity Matrix) for the effective deployment of the imaging support workforce. A Public Summary encapsulated the key findings for imaging services, the wider healthcare community, and for patients and the public. National Health Service Electronic Staff Record database (n = 144 National Health Service Trusts); interviews (n = 38); focus groups (n = 15); documentary analysis (n = 48). The support workforce (National Health Service pay Bands 2-4) constitutes 23.6% of the non-medical imaging workforce (22.2% median, interquartile range 14.9-29.1). Opposing deployment models were identified, based on grade preference (Band 2 or Band 3) and role flexibility (static or rotational). Wide variations in job titles, roles, grades, competencies and scopes of practice are evident both between National Health Service Trust hospitals and within individual imaging departments. With the exception of breast imaging, assistant practitioners (Band 4) appear underutilised in most imaging services. Inconsistent and incomplete data in the Electronic Staff Records potentially compromised data quality; however, subsequent participant-supplied data were comparable. Imaging support workers are 'absolutely pivotal' to smooth patient workflow and the patient experience; however, unwarranted variations in support workforce deployment and utilisation compromise recruitment, retention, career progression and innovation. This workforce appears to be operationally managed rather than strategically planned which potentially limits the impact of the support workforce on the wider imaging workforce crisis. The Imaging Support Workforce Maturity Matrix provides a management tool to support review and harmonisation of the imaging support workforce at national, regional, hospital, imaging department and modality levels. A widespread reluctance to fully utilise Assistant Practitioners and enable them to seamlessly progress to registered practice requires further investigation. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR133813.

Identifying clinical deterioration is a global health priority. Sepsis is a leading cause of deterioration, responsible for around 46,000 deaths annually in the United Kingdom. Early warning scores based on patients' vital signs can be embedded into electronic patient records to digitally alert clinicians to those at risk. Rapid identification and treatment - particularly with targeted intravenous antibiotics - are critical to improving outcomes in sepsis patients. This study aimed to evaluate the effectiveness of digital alerts in improving outcomes for patients with sepsis. Using routine electronic patient record data from four United Kingdom National Health Service acute trusts, we investigated how digital alert systems influence patient outcomes and explored mechanisms and mediators of their effectiveness. Map the types of digital alerts currently in use across United Kingdom hospitals for identifying patients at risk of sepsis (Workstream 1). Evaluate the impact of digital alerts on patient outcomes (Workstream 2). Examine how the implementation process affects alert performance, guided by the consolidated framework for implementation research (Workstream 3). Provide recommendations on alert effectiveness and implementation strategies using systems modelling and mediation analysis (Workstream 4). A mixed-methods approach was employed. A national survey assessed the use of digital sepsis alerts in English National Health Survey hospitals (Workstream 1). Qualitative interviews and focus groups explored the implementation process and its influence on alert performance (Workstream 3). A natural experiment with multilevel interrupted time series analysis examined the impact of sepsis screening tools and digital alerts on outcomes, primarily in-hospital mortality (Workstream 2). Routinely collected clinical data were processed following National Institute for Health Research-Health Information Collaborative standards. Combining quantitative and qualitative data enabled us to link implementation processes with patient outcomes. All four trusts experienced reduced mortality rates among patients with serious infections following the introduction of digital sepsis screening tools. After adjustment for patient case-mix, admission patterns and pre-existing trends, one trust showed a statistically significant decrease in mortality linked to digital alert implementation. In two trusts, older patients experienced greater mortality reduction than younger ones following alert introduction. Qualitative findings highlighted factors contributing to more effective use of digital alerts: deployment in general wards rather than intensive care units; use by clinicians familiar with similar technologies; availability of 24/7 emergency outreach teams; robust technological infrastructure and alerts that were user-friendly, non-intrusive and not part of multiple competing alert systems. The effectiveness of digital sepsis screening tools varies and may depend on patient's age and care setting. Our findings suggest that digital alerts should leverage a wider range of electronic patient record data and be tailored to specific patient groups. Different trusts and patient populations may require distinct indicators, thresholds and treatment protocols. These findings align with healthcare practitioners' calls for more sophisticated, patient-centred sepsis screening tools targeted at relevant clinical teams. The study involved four National Health Service Trusts with strong data collaboration, but noted limitations include reliance on simple algorithms and varied case-mix and implementation processes. Future research should focus on robust evaluation methods, leveraging granular electronic patient record data and establishing a public registry of digital alert tools. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR129082.

The National Health Service in England is piloting an extension of access to its Digital Weight Management Programme, a digital service to support behavioural and lifestyle changes for weight loss. Access is being piloted to include referrals for patients with a body mass index above a threshold level set by the National Health Service England and who either have a diagnosis of osteoarthritis of the knee or hip (musculoskeletal referrals - 11 pilot sites) or are on elective surgical care waiting lists (elective care referrals - 10 pilot sites). There is a marked variation across sites in the number of patients referred. To understand reasons for variation (local implementation, barriers and facilitators) and experiences of the implementation and functioning of referral pathways for musculoskeletal and elective surgical care patients into the National Health Service Digital Weight Management Programme. A comparative case study (n = 7 sites) methodology was used, employing a mixed-methods approach following a sequential explanatory design: descriptive analysis of quantitative referral data from National Health Service England; staff (n = 25) and patient (n = 18) interviews and online workshops. Thematic analysis was conducted. Osteoarthritis treatment and elective surgery providers in the National Health Service in England. Interviews: staff and patients at three musculoskeletal and four elective care pilot sites. Workshops: staff at all pilot sites. Referral of osteoarthritis and elective surgery patients to the National Health Service Digital Weight Management Programme. Patients' and staff's views. Sites that created referral processes that optimised clinical staff time (e.g. automation and use of administrative staff) and involved ways to capture body mass index if missing from patient records were more likely to have a higher number of referrals. Despite generally positive attitudes towards the Programme, many staff felt they had insufficient information to describe it accurately to patients, which may impact both offering and acceptance of referrals. Strong leadership and personal staff motivation arealso likely to impact referral offers. Similarly, patients were more likely to accept a referral if it aligned with their attitudes towards weight management and was offered at a time where they felt they could engage with the Programme. Data were available on numbers of patients referred but not on numbers of eligible patients not referred. All patients interviewed had accepted referral to the Programme: we were unsuccessful in our attempts to recruit patients who had declined referral. No patients from minority ethnic groups volunteered to be interviewed. There is a considerable variation between case study sites in the details of how they have implemented new pathways for referring patients to the National Health Service Digital Weight Management Programme. These differences likely reflect varying local contexts. No single best model for the referral pathways has been identified. It would be desirable to capture the experiences of patients from diverse ethnic backgrounds and from patients who declined referral. Larger, longitudinal and observational studies could help understand the specifics of referral conversations as well as the effectiveness and cost-effectiveness of these referral pathways against other pathways to the Programme to aid decision-making and development of support materials for staff. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR167932.

Women who use drugs during the perinatal period often have complex health and social care needs. Their infants can experience developmental and health problems. Despite United Kingdom's guidelines and policies on the care of pregnant women and mothers who use drugs, there is little evidence of the services that are available in the United Kingdom and whether they meet the needs of women and their infants. This study sought evidence of (1) best practice models for care that have the potential to interrupt the transmission of adversity across generations and (2) the views and experiences of women and staff on different models of care and how services could be improved. The study involved systematic reviews, longitudinal qualitative research and coproduction. There were three phases. In phase 1, an Expert Advisory and CoProduction Group was established to guide the research and to develop a theory of change for improved service models. The group comprised multidisciplinary stakeholders from health and social care and peer advisers. Two reviews were undertaken: A scoping review of UK guidance for perinatal care for women who use drugs included 111 documents, recommending integrated multidisciplinary working. A mixed-methods systematic review of evidence of integrated models of perinatal care for women who use drugs and their babies reviewed 197 studies. Qualitative findings suggest that women appreciate collocated services that are easy to access. Quantitative findings found evidence that integrated programmes at the point of delivery decrease substance use during the perinatal period. Phase 2 involved a qualitative longitudinal study in four sites, two in England and two in Scotland, that aimed to explore perinatal care pathways. Up to five interviews were conducted with 36 women, from early pregnancy up to 18 months post natal (131 interviews). Many women experienced stigma and were anxious about social services' involvement. Access to residential treatment and mental health support was uneven. Support for women who had lost care of their babies was poor. Focus group interviews (79 staff) and individual interviews (21 staff) were conducted with health and social care practitioners. Staff reported that high caseloads, staff turnover and training gaps contributed to difficulties in providing care to this challenging group. In phase 3, the Expert Advisory and CoProduction Group worked with the research team to develop a theory of change for recommendations for an optimised service model. The theory of change identified eight key recommendations and emphasised that a whole-system approach is required to meet the complex needs of this population. For the quantitative findings of the mixed-methods systematic review, the diversity of study types made it difficult to draw firm conclusions on the effectiveness of different approaches. Not all women recruited to the qualitative longitudinal study took part in all the anticipated interviews. There is a need for high-quality research studies into effective interventions for pregnant women who use drugs. Implementation research is required to test and implement the theory of change for optimum services for women who use drugs in the perinatal period. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR130619.

People with severe mental illness (e.g. bipolar disorder, psychosis) experience poor oral health compared to the general population. They are more likely to have decayed, missing or filled teeth, and periodontal disease, which can affect quality of life and functioning. It can add to the burden of living with severe mental illness. Dentists can prevent and treat oral health problems. However, people with severe mental illness experience profound and multifaceted barriers to attendance, including practical issues, financial difficulties and dental anxiety. Unfortunately, existing dental interventions have not addressed these issues. They have not helped people with severe mental illness to attend the dentist. This project aimed to develop and evaluate a link work intervention, delivered by mental health support workers, to enable dental access in people with severe mental illness. The intervention attempted to help people to navigate dental systems and bridge the gap between services. There were four work packages: Work package 1 involved 4 co-production workshops with patients, staff, and carers (7, 6, 8 and 12 attendees, respectively). We used this information to co-develop and refine the link work intervention and associated training materials. This step ensured that the intervention was relevant and helpful to people with mental health difficulties. Work package 2 was a realist review to understand the contexts and resultant mechanisms by which link work interventions affect access to community healthcare services. A search of empirical and grey literature identified 31 reports. The analysis resulted in nine context, mechanism, and outcome configurations within three theory areas, providing useful information on how and why link work interventions might be helpful. Work package 3 was a feasibility randomised controlled trial of a link work intervention to support dental access in people with severe mental illness who had not attended a routine dental appointment in the past 3 years. Seventy-nine out of the target 84 participants were randomised to receiving either treatment as usual or treatment as usual plus the link work intervention. The majority of the feasibility criteria were met and there was high engagement with the intervention. Uptake of an optional dental examination was low at follow-up (12.7%; 95% CI: 7.0% to 21.8%). There were no serious adverse events attributable to the intervention or trial procedures. Overall, the findings supported progression to a full trial. Work package 4 was an embedded qualitative evaluation of the link work intervention and trial. Narrative-informed interviews were carried out with 18 participants in the trial (13 in the intervention arm, 5 in the treatment as usual arm) and 3 link workers. The qualitative data suggested high levels of interest and engagement from stakeholders, and need for dental intervention. The link work intervention offered practical and emotional support at different stages of access to address barriers to dental visiting at the individual, relational and organisational level. Overall, the project successfully developed and evaluated a link work intervention to enable dental access in people with severe mental illness. The authors followed participants up after 9 months and the feasibility of longer-term retention is unknown. The next step is to explore the effectiveness and cost-effectiveness of the link work intervention through a full trial. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR132853.