North-west Region Of England Research Articles

Supporting students to return to study following course interruption (SuTuRe).

The pre-registration BSc Nursing course in the UK is renowned for being challenging due to its requirement for 2300 hours each for theoretical and practice-based learning. It is therefore inevitable that some students may need to interrupt their study at some point during the course. In many cases, these students do not return and leave the course, which has an impact on the future nursing workforce. To examine the reasons why pre-registration student nurses interrupt their studies and consider ways to enable them to return successfully and complete the course. The research project was based in one higher education institution (HEI) in the North West region of England. Interrupted students due to return to study in semester 1 of the 2022/23 academic year (n=95) were invited to participate in semi-structured interviews. Health, including mental health was the dominant factor leading to the interruption of study for the students. This research has led the HEI to introduce an improved support package for students. Alongside other recommendations it is hoped the changes will reduce attrition and lead to an improved interruption/return-to-study experience.

P081 Out-patient management of gout in secondary care: Results from the North West regional audit

Abstract Background/Aims Recommendations for gout management have significantly evolved as outlined by the latest National Institute for Health and Care Excellence (NICE), European League Against Rheumatism (EULAR), British Society for Rheumatology (BSR) and the Medicines and Healthcare products Regulatory Agency (MHRA) guidelines, with increased emphasis being placed on optimising cardiovascular risk. This regional audit aimed to assess concordance with these guidelines within rheumatology outpatient settings in the North West region of England. Methods New or follow-up patients with gout, presenting to a rheumatology outpatient setting within the Greater Manchester and Lancashire area over a five-week period between 1/3/23 and 7/4/23 were included. We collated data on demographics, co-morbidity assessment including cardiovascular risk, prescribing of febuxostat in major cardiovascular disease, diuretic use and advice, setting of treat-to-target levels, use of cardiovascular risk prediction tools and subsequent follow up arrangements. For new patients, collected data also included referral reason, and prescription recommendations for first-line urate-lowering therapy (ULT) and co-prescriptions for flare prophylaxis. Results Ninety-two patients (mean age 60 years, 80% male) were included from 13 rheumatology departments. Twenty-three patients were new referrals. Sixty-seven patients (73%) had ≥ 1 relevant comorbidity; hypertension being the most common (55%). Twenty (22%) patients were on diuretics. Twelve (55%) of these patients had a diagnosis of hypertension without heart failure; none received recommendations to reduce or stop diuretics. In line with current guidelines, no patient with major cardiovascular disease was treated with febuxostat. Treat-to-target levels were agreed in 49 (57%) applicable patients. Cardiovascular prediction tools were only calculated or known in three (3%) patients. However, clinic data collected would have allowed a risk assessment calculation in 13 (14%) patients. Sixteen (17%) patients audited had no planned follow-up. Compared to NICE guidelines, 18 (78%) new patients reviewed in clinic were referred appropriately to rheumatology services. Twenty-two (96%) new patients referred were eligible to start ULT, of which 15 (75%) were started on a NICE/ EULAR recommended first-line ULT treatment (14 patients on allopurinol including 11 patients with no major cardiovascular disease, one patient on febuxostat). Eleven (79%) patients started on allopurinol were initiated on a low dose (50-100mg), as recommended by NICE and the BSR. Ten (67%) patients of those initiated on ULT were also prescribed prophylactic colchicine. Two additional patients were prescribed NSAIDs with PPI cover and one patient was prescribed oral steroids without PPI cover. Conclusion Most new patients were referred and prescribed first-line ULT treatment appropriately, often with colchicine prophylaxis. Uptake of febuxostat as first-line therapy was limited. Cardiovascular risk assessment was rarely done; further work exploring barriers to undertaking these assessments in rheumatology clinics is likely to improve both patient care and guideline compliance. Disclosure L. Gould: Other; L.G. has received conference fees from Eli Lilly. A. Richards: None. L. Gray: Other; L.G. has received travel and conference fees from Eli Lilly. M. Badarulla: Other; M.B. has received conference fees from Eli Lilly. L. Mercer: Other; L.M. has received conference fees from Nordic Pharma and UCB. R. Farid: None. R. Heaton: Consultancies; R.H. has received consultancy fees from Galapagos. Honoraria; R.H. has received speaker honorarium from Abbvie and Nordic. Other; R.H. has received conference fees from UCB. M. Al-Attar: None. M. Whitehead: None. S. Kamath: None. L. Teh: None. A. Odekunle: None. C.A. Sharp: None. A. Babiker: None. S. Hopping: None. A. Oldroyd: None. K. Lazarewicz: None. C. Saleh: None. S. Horton: None. D. Roy: Honoraria; D.R. has an honorary University of Manchester research assistant contract. A. Opeseyitan: None. D. Das: None. S. Varughese: None. D. Yidana: None. S. Wig: None. J. Bluett: Grants/research support; J.B. has received a research grant award from Pfizer. Other; J.B. has received travel/conference fees from UCB, Fresenius Kabi, Pfizer and Eli Lilly.

Unravelling the dynamics of mental health inequalities in England: A 12-year nationwide longitudinal spatial analysis of recorded depression prevalence

BackgroundDepression is one of the most significant public health issues, but evidence of geographic patterns and trends of depression is limited. We aimed to examine the spatio-temporal patterns and trends of depression prevalence among adults in a nationwide longitudinal spatial study in England and evaluate the influence of neighbourhood socioeconomic deprivation in explaining patterns. MethodsInformation on recorded depression prevalence was obtained from the indicator Quality and Outcomes Framework: Depression prevalence that measured the annual percentage of adults diagnosed with depression for Lower Super Output Areas (LSOA) from 2011 to 2022. We applied Cluster and Outlier Analysis using the Local Moran’s I algorithm. Local effects of deprivation on depression in 2020 examined with Geographically Weighted Regression (GWR). Inequalities in recorded prevalence were presented using Prevalence Rate Ratios (PRR). ResultsThe North West Region of England had the highest concentration of High-High clusters of depression, with 17.4% of the area having high values surrounded by high values in both space and time and the greatest percentage of areas with a high rate of increase (43.1%). Inequalities widened among areas with a high rate of increase in prevalence compared to those with a lower rate of increase, with the PRR increasing from 1.66 (99% CI 1.61–1.70) in 2011 to 1.81 (99% CI 1.76–1.85) by 2022. Deprivation explained 3%–39% of the variance in depression in 2020 across the country. ConclusionsIt is crucial to monitor depression's spatial patterns and trends and investigate mechanisms of mental health inequalities. Our findings can help identify priority areas and target prevention and intervention strategies in England. Evaluating mental health interventions in different geographic contexts can provide valuable insights to policymakers on the most effective and context-sensitive strategies, enabling them to allocate resources towards preventing the worsening of mental health inequalities.

An analysis of cooking fire injuries 2011 to 2022 in Merseyside UK

In England, cooking fires are the most common type of accidental dwelling fire. In this article we examine cooking fire injuries over the period 2011 to 2022 in Merseyside in the North West region of England. Cooking fire injuries occurred at all times of day, however mainly such injuries occurred during evening meal time. Almost 30% of cooking fire injuries occurred overnight (between 10:00 p.m. and 7:00 a.m.). The risk of cooking fire injuries was present for all age groups, however this increased for those aged 75 and over, and increased further for those aged 85 and over. The greater the level of deprivation of an area, the higher the rate of cooking fire injuries. There was a strong correlation between the IMD decile (an English standard measure of deprivation) and the rate of cooking fire injuries per 100,000 population of 0.95. The use of a chip pan or deep fat fryer was associated with 35% of the cooking fire injuries over the period studied. The consumption of alcohol/drugs was a contributory factor in 17% of the cooking fire injuries over the time period studied.

“I don’t know what I’m feeling for”: young women’s beliefs about breast cancer risk and experiences of breast awareness

BackgroundYounger women are often diagnosed with advanced breast cancer. Beliefs about risk are instrumental in motivating many health protective behaviours, but there may be confusion around which behaviour is appropriate to detect breast cancer earlier. Breast awareness, defined as an understanding of how the breasts look and feel so changes can be identified early, is widely recommended. In contrast, breast self-examination involves palpation using a specified method. We aimed to investigate young women’s beliefs about their risk and experiences of breast awareness.MethodsThirty-seven women aged 30–39 years residing in a North West region of England with no family or personal history of breast cancer participated in seven focus groups (n = 29) and eight individual interviews. Data were analysed using reflexive thematic analysis.ResultsThree themes were generated. “Future me’s problem” describes why women perceive breast cancer as an older woman’s disease. Uncertainty regarding checking behaviours highlights how confusion about self-checking behaviour advice has resulted in women infrequently performing breast checks. Campaigns as a missed opportunity highlights the potential negative effects of current breast cancer fundraising campaigns and the perceived absence of educational campaigning about breast cancer for this demographic.ConclusionsYoung women expressed low perceived susceptibility to developing breast cancer in the near future. Women did not know what breast self-checking behaviours they should be performing and expressed a lack of confidence in how to perform a breast check appropriately due to limited knowledge about what to look and feel for. Consequently, women reported disengagement with breast awareness. Defining and clearly communicating the best strategy for breast awareness and establishing whether it is beneficial or not are essential next steps.

Accelerating sustainability transitions: the case of the hydrogen agenda in the North West region of England

Low-carbon hydrogen can assist in addressing the global crisis of climate change by significantly decarbonizing a range of heavy-emitting sectors. In the United Kingdom, hydrogen technologies are at the forefront of the net zero-emission roadmaps of many industrial clusters. However, with impending timeframes linked to emission targets and other decarbonization objectives, it is increasingly important to understand how to accelerate such transitions to hydrogen. There is, to date, a notable gap in the academic literature concerning the acceleration of sustainability transitions. Using the case of the hydrogen agenda in England’s North West region, we explore how the transition to hydrogen can be accelerated and thus begin to contribute toward filling this omission. In doing so, we use data collected through semi-structured interviews and from the public domain to unpack and develop upon an existing framework that emerged from the European Commission funded-project Accelerating and Rescaling Transitions to Sustainability (ARTS). The framework comprises five acceleration mechanisms which local sustainability transition initiatives have adopted. This analysis generates novel findings in relation to why actors in the region have faced difficulties in instrumentalizing as well as the mechanism’s overall importance in acceleration. We use these challenges to inform several recommendations which policy makers could adopt to accelerate the North West’s, and wider UK’s, transition to hydrogen.

Disruptive Localism – How Far Does Clientelism Shape the Prospects of Neighbourhood Planning in Deprived Urban Communities?

ABSTRACT This paper reports on a study of Neighbourhood Planning in more deprived urban areas of the North West region of England, revealing that the stance of elected representatives is important in shaping the processes and outcomes of this new more citizen-led form of planning. The paper considers how far barriers to Neighbourhood Planning, and the variable support offered by local planning authorities to deprived urban communities, might be accounted for by practices of clientelism. It concludes that clientelism provides a useful lens through which to interpret attitudes towards Neighbourhood Planning as a disruptor of established patterns of influence and powerholding.

Multiple hospitalisations towards the end of life among patients with serious mental illness: A retrospective cohort study in England, UK

IntroductionMultiple hospitalisations towards the end of life is an indicator of poor-quality care. Understanding the characteristics of patients who experience hospitalisations at the end-of-life and how they vary is important for improved care planning.ObjectivesTo describe socio-demographic and clinical characteristics of patients diagnosed with serious mental illness who experienced multiple hospitalisations in the last 90 days of life.MethodsData for all adult patients with a diagnosis of serious mental illness who died in 2018-2019 in England, UK were extracted from the National Mental Health Services Data Set linked with Hospital Episode Statistics and death registry data. Variables of interest included age, gender, marital status, underlying and contributory cause of death, ethnicity, place of death, deprivation status, urban-rural indicator, and patient’s region of residence. The number of hospitalisations and patient’s sociodemographic & clinical were described using descriptive statistics and percentages, respectively.ResultsOf the 45924 patients, 38.1% (n=17505, Male=42.9%, Female=57.1%, Mean age:78.4) had at least one hospitalisation in the last 90 days of life. The median number of hospitalisations was 2(StdDev:1.64, Minimum=1,Maximum=23). Most of those hospitalised (n=11808, 67.5%), died in a health care establishment (e.g. Hospital or hospice). There were marked geographic differences in the proportions of hospitalisations.The North West region of England recorded the most hospitalisations (n= 2906,16.6%), compared to other regions.ConclusionsFurther analysis is needed to understand factors independently associated with hospitalisations in people with serious mental illness. Funding: This project is supported by the National Institute for Health Research (NIHR) Applied Research Collaborations (ARC) South London.

P178 Variation in assessment of outcomes for inflammatory bowel disease in routine clinical practice: a mixed-methods study

Abstract Background A number of global initiatives have sought to standardise the assessment of outcomes for inflammatory bowel disease (IBD), both for clinical trials (Core Outcome Sets1) and routine practice (ICHOM2). Our aim was to explore variability in the assessment and recording of clinical IBD outcomes during routine practice in England, evaluating the range of individual outcomes elicited and the extent of objective quantification of symptoms. Methods We performed ethnographic observations of 102 IBD clinic consultations conducted by 24 IBD clinicians (10 consultants, 10 IBD nurses and 4 trainees) in six acute hospitals in the North West region of England. We analysed 909 retrospective clinic records from outpatient IBD clinic visits recorded for observed patients in routine electronic patient records (EPRs). Audio-recordings of observed consultations and clinic records were analysed for pre-defined IBD outcomes, including those items required for Crohn’s Disease Activity Index (CDAI), Harvey–Bradshaw Index (HBI), Mayo Clinic Score (MCS) and Simple Clinical Colitis Activity Index (SCCAI). In addition, we performed 24 semi-structured interviews with IBD clinicians to explore the barriers and facilitators to capturing structured IBD outcomes in EPRs. Results The most commonly elicited and recorded outcomes were general well-being (95% consultations [C] and 61% clinic records [R]), stool frequency [SF] (87% C, 68% R), abdominal pain [AP] (79% C, 46% R), blood in stool [BS] (71% C, 57% R) and loose stool (64% C, 51% R). Clinical disease activity indices (HBI and SCCAI) were collected in only 15 (14.7%) observed consultations and recorded in 51 (5.6%) clinic letters. There was marked variation in the quantification of individual symptom items of MCS, SCCAI, CDAI and HBI in analysed consultations and records. Both PRO2 Crohn’s disease outcomes [AP and SF] were collected in 29/50 (58%) observed consultations and recorded in 169/484 (35%) records. Both PRO2 ulcerative colitis outcomes [SF and BS] were collected in 42/52 (81%) consultations and 253/425 (60%) records. Selected outcomes were recorded significantly more frequently by IBD nurses compared with doctors. Clinicians reported a range of IT barriers and issues with psychometric properties of currently available clinical disease activity indices in practice. Conclusion There is significant variability in the breadth, depth and quantification of IBD clinical outcomes during routine clinical assessments. Although most domains of clinical disease activity indices were elicited in consultations, formal scoring and assessment over fixed time periods was rare. There is an urgent need for practical alternatives to clinician reported disease activity indices in routine care.

Developing Reflective Thinking through Poetry Writing: Views from Students and Educators.

Aims and Objectives To explore student nurse and educator perspectives on the use of poetry writing as a way to reflect on important nursing practice issues. Background Reflective practice is a well-established method of learning in pre-registration nurse education although student nurses can find reflection a challenging process. Design An exploratory descriptive approach. Methods Data were extracted from unstructured interviews with students and educators (n = 12) from one university in the North-West region of England, United Kingdom (UK). Data were thematically analysed. Results Poetry writing supports a meaningful exploration of events, which have the potential to lead to changes in perspective. Careful planning of the poetry writing process is required, to ensure the potential of this approach is realised. Conclusion Poetry writing is an effective way to reflect on clinical practice. This work has relevance and transferability to a wide range of professional disciplines, where reflective practice is encouraged.

Advancing quality in sepsis management: a large-scale programme for improving sepsis recognition and management in the North West region of England

ObjectiveTo evaluate the impact of a collaborative programme for the early recognition and management of patients admitted with sepsis in the northwest of England.Setting14 hospitals in the northwest of England.InterventionA...

Clinical care and other categories posters: Psychological health

Aims: It is unclear how work-related characteristics affect quality of life among people with diabetes. We examined the influence of psychosocial work characteristics on quality of life among people with Type 1 and Type 2 diabetes. Methods: Study packs were posted to addresses of individuals with diabetes who attended two acute trusts in the north-west region of England. Eligible individuals were asked to read a participant information sheet about the study and then sign consent forms prior to participation. Questionnaires were used to collect data on personal characteristics (demographic questionnaire), quality of life (audit of diabetes-dependent quality of life questionnaire) and participants’ work characteristics (job content questionnaire). Depending on their measurement scale, chi-square test, independent t-test or relevant correlation co-efficient was used to investigate associations between variables. Statistical analyses were conducted using SPSS (version 22). The Newcastle & North Tyneside Ethics Committee approved the study. Results: A total of 123 (51%) men and women with Type 1 and Type 2 diabetes participated in the study. Over half (53%) of participants were individuals with Type 2 diabetes. Compared to people with Type 1, participants with Type 2 diabetes were more likely to report poor quality of life (p < 0.05). Various work-related characteristics were significantly associated with quality of life. Participants who experienced high psychological job demands were more likely to report poor quality of life compared to those with low demands (mean ± SD = 38.88 ± 6.38 vs 32.34 ± 5.89, p < 0.01). Conclusions: Changes in the type of work and/or adjustments to job characteristics may improve quality of life among working populations with diabetes.

1133P - Non-elective admissions in cancer care - A review of acute oncology services (AOS) implementation in a north-west region of England

Background: Parallel to advances in cancer therapeutics in the clinics, high quality and patient-centred management of cancer or treatment-related complications during non-elective attendance especially to a non-specialist hospital is crucial in achieving excellent patient outcome. AOS was innovated in the UK to meet this need and has rapidly expanded in recent years. Here, we describe findings of an on-going audit of this expanding networked service within Greater Manchester and Cheshire East County consisting of 10 district general hospitals in collaboration with a regional specialist cancer centre (The Christie NHS Foundation Trust). Methods: Information related to any hospital episodes warranting AOS input was collated from all participating hospitals using standardised proforma and analysed. Results: Between Jan 2015 - Sep 2016, 7638 non-elective hospital attendances were recorded of which 58% occurred within working hours. Common cancer sites were lung 16%, breast 15%, lower GI 12%, urology 12%, upper GI and HPB 9%, haematology 7%, gynaecology 6%, cancer of unknown primary(CUP) 6%, and others 7%. Majority were related to cancer complication 40% (Type III), treatment - related 32% (Type II), new cancer diagnosis 10% (Type I) and others 17%. 94% of AOS involvement occured within 24hr of attendance. Level of intervention by AOS was considered major in 60% while 30% and <10% was intermediate or minor respectively. Median length of stay (LOS) is 4 days, 20% of episodes lasted <24hr (11.2% admission avoidance), 50% 1-7 days, and 30% 2-6 weeks (predominantly type I and III). Conclusions: This large multi-sites audit documented the service delivery pattern of a growing oncology subspecialty at the same time provided a glimpse into the healthcare implication of unplanned admission in the current era of advancing oncology lanscape. Excellent median LOS in this region compared to national average likely a reflection of pertinent AOS team involvement in a timely manner. AOS is now an integral component to the cancer care in the UK and its role in the non-elective setting serves to ensure excellent patient experience as well as providing far-reaching potential in healthcare efficiciency. Legal entity responsible for the study: not applicable Funding: None Disclosure: All authors have declared no conflicts of interest.

The influence of role models in undergraduate nurse education.

To explore the concept of role modelling in undergraduate nurse education and its effect on the personal and professional development of student nurses. Effective educative strategies are important for student nurses, who have to cope with learning in both clinical and university settings. Given the contemporary issues facing nurse education and practice in the United Kingdom (UK), it is timely and important to undertake pedagogical research into the concept of role modelling as an effective educative method. A descriptive narrative approach. Unstructured interviews were conducted with 14 current/recently discontinued students from Adult and Mental Health branches of nursing degree programmes in the north-west region of England, United Kingdom (UK). Data were thematically analysed. Students valued exposure to positive role models in clinical and university settings and viewed them as beneficial to their learning. Exposure to negative role models occurred, and this provided students with opportunities to consider the type of nurse they aspired to become. In some cases, students' exposure to perceived poor practice had an adverse effect on their learning and led to negative feelings about nursing work. Clinical staff might be perceived as more relevant role models than those in the university setting although there were still opportunities for academic staff to model professional behaviours. The study found that role modelling is an effective way to support learning and led to student satisfaction across both clinical and university settings. The findings support the use of role models in nurse education, and further research about conscious positive modelling of practice is required. Exploring the use of role models is important when examining ways in which the quality of nurse education might be developed.

An exploration of alcohol-related fire incidences

In this paper we examine an operational research project concerning the analysis of the characteristics of alcohol-related fire instances attended by a UK Fire and Rescue Service in the North West region of England and the development of a geographical information system for fire prevention support. The research project examined the circumstances of alcohol-related fires, their geographical distribution and the socio-economic characteristics of such fire incidences within the region studied, and also involved the design and implementation of a geographical information system for supporting prevention of such fires. Overall, it was found that cooking fires involving ‘harmful’ or ‘hazardous’ levels of alcohol consumption were most likely to be found amongst younger urban residents living in high levels of deprivation, students living in city centre locations and young families with high benefit need within the region studied.

Strategic spatial planning under regime governance and localism: experiences from the North West of England

Perceiving strategic spatial planning as a usually supra-local exercise, this paper examines the extent to which five identified key functions of strategic spatial planning can be fulfilled where institutionalised under the regime gouvernance of city regions and localism. In England, such systems are reflected in the establishment of Local Enterprise Partnerships (LEPs) and a Duty to Cooperate, which tries to engage local authorities in joint fulfilment of strategic planning functions. In response to often negative findings in the literature, this study adopted a ‘high potential’ approach to case study selection in the north-west region of England. The paper concludes that the five key functions of strategic spatial planning involving comprehensive insight, contextual judgements, political courage for consensus building, institution building and recognition of future opportunities and threats are generally not effectively fulfilled under regime governance and localism. The overarching suggestion is, there...

In pursuit of productive conflict in strategic planning: project identification

ABSTRACTThis paper discusses three normative standpoints on conflict in strategic spatial planning: no conflict, conflict for consensus and conflict for meta-consensus on the validity of dispute. These views apply to the questions of whether and why projects, as a major source of conflict, should be identified in the process of strategic planning. In their approaches to these questions, the performance school advocates the production of general guidelines to avoid conflict, the collaborative perspective supports the identification of projects in strategic planning in order to utilize their potential in a conflict-to-consensus journey and the conflict-oriented perspective favours the identification of projects in strategic planning in order to arrive at meta-consensus on the immediate disputability of robust agreements. Reflecting on the collaborative perspective, this paper tests a hypothetical model of how conflicts created in the face of project identification can feed in making consensual strategies. Findings in the North West region of England support the model and suggest some difficulties with reviewing such consensus around which a resistance network forms. The paper puts forward some recommendations for overcoming the review challenge.

Meta-governance and soft projects: A hypothetical model for regional policy integration

Reflecting on the concepts of meta-governance and soft projects, this study involves testing a hypothetical model for regional policy integration which incorporates three core assumptions: (a) collaborative regional institutions are likely to step out of their comfort zone and engage in project discussions where there are managerial regional institutions which have the potential to incorporate such projects and take them forward; (b) soft projects, like regional parks, unleash such potential since they can involve a wide range of objectives and activities and thus provide an opportunity for managerial regional institutions to procure legitimacy by wider inputs at low cost; and (c) collaborative regional institutions tend to overcome their initial internal differences about such projects in order to develop network power in relation to managerial regional institutions. This hypothetical model is supported by case study findings in the North West region of England, feeding in a discussion about some priorities for future research.

Building consensus for network power? Some reflections on strategic spatial planning in the North West region of England

This case study of collaborative regional spatial planning in the North West region of England seeks to understand if ‘network power’ provides a sufficient incentive for the politically stronger and institutionally established players (particularly local government) to adopt a more flexible approach to consensus building. An observed failure in this respect, due to the overwhelming strength of the parochial interests of local government under network governance, leads to a suggestion to incentivise greater collaboration and consensus building at the strategic level through what has been termed ‘meta-governed citizen power’.

Urology higher specialist training in North London and North West England: a comparison of two training regions in the UK

Introduction: Local education training boards (LETBs) and deaneries are under pressure to demonstrate delivery of high quality specialist urology training. There is at present no quality tool used routinely to demonstrate this quality regionally or nationally. Differences in training could therefore exist between different regions, and locally between different training units. A trainer/trainee questionnaire tool previously piloted by the specialist advisory committee was used to evaluate urology training posts in the North London LETB over 3 years. The findings were used to compare trainee scores in North London with those in the North West region of England. Materials and methods: Questionnaires were circulated electronically to all higher surgical urology trainees in the 18 training units affiliated to the North London LETB. Three years of trainee data were collated, statistically analysed and compared to those collected by Oates and colleagues, looking for any differences in regional trainee scores for higher surgical training posts in North London and North West of England regions. Results: The mean trainee response rate was 28 questionnaires per year from all 18 units in the North London region. Combined mean and median scores were 83.3 and 84, respectively. This compares to 86.2 and 88.1 from North West England region comprising eight units. There was no statistically significant difference in scores between the two regions (two-tailed t test, P=0.31). Conclusion: There is no statistical difference in trainee scores for the evaluation of urological training posts between the two regions. The questionnaire tool can be used effectively to look at overall differences in training standards between geographically distinct regions from a trainee perspective. Both regions offer higher surgical training with high levels of trainee satisfaction. This questionnaire tool can provide insight into subjective differences in training posts within a region.