Southwest England Research Articles

Biomonitoring of microplastics, anthropogenic microfibres and glass retroreflective beads by marine macroalgae

Microplastics and other microscopic debris are a concern in the coastal environment but measurements in the water column and sediment are often problematic and rely on non-standardised and highly variable methodologies. To this end, we explore the potential of different species of temperate-cold marine macroalgae as passive biomonitors of anthropogenic microparticles at three contrasting locations in southwest England. Specifically, fronds from samples of fucoids and Ulva lactuca (n = 9 in total, and three from each location) have been sectioned and analysed directly under a microscope and anthropogenic microparticles counted and subsequently characterised for chemical composition. Microparticles were heterogeneously distributed throughout sections from the same sample. However, on a dry weight basis, combined microparticle concentrations for each sample ranged from about 7.5 g-1 to 110 g−1, and from about 0.2 cm−2 to 0.9 cm−2, and for a given species were higher in samples from a semi-enclosed harbour and urban beach than in samples from a protected beach facing the open sea. These values compare with published concentrations of microplastics and microfibres reported for the regional water column on the order of 0.1 m-3. Most particles were cellulosic (e.g., rayon) and petroleum-based (mainly polyester and polyethylene terephthalate) fibres but plastic fragments were also present on most samples. Glass retroreflective beads derived from road markings were also present at up to 18 g−1 on fucoids from the urban beach because of its proximity to a stormwater effluent. Most microparticles were adhered to the smooth parts of the macroalgal surface but some displayed wrapping around edges and creases or entrapment by appendages. The practical and environmental implications of macroalgae passively capturing significant quantities of anthropogenic microparticles are discussed.

Co-designing adult weight management services: a qualitative study exploring barriers, facilitators, and considerations for future commissioning

BackgroundWeight management services have not always benefitted everyone equally. People who live in more deprived areas, racially minoritised communities, those with complex additional needs (e.g., a physical or mental disability), and men are less likely to take part in weight management services. This can subsequently widen health inequalities. One way to counter this is to co-design services with under-served groups to better meet their needs. Using a case study approach, we explored how co-designed adult weight management services were developed, the barriers and facilitators to co-design, and the implications for future commissioning.MethodsWe selected four case studies of adult weight management services in Southwest England where co-design had been planned, representing a range of populations and settings. In each case, we recruited commissioners and providers of the services, and where possible, community members involved in co-design activities. Interviews were conducted online, audio-recorded, transcribed verbatim, and analysed using thematic analysis.ResultsWe interviewed 18 participants (8 female; 10 male): seven commissioners, eight providers, and three community members involved in co-designing the services. The case studies used a range of co-design activities (planned and actualised), from light-touch to more in-depth approaches. In two case studies, co-design activities were planned but were not fully implemented due to organisational time or funding constraints. Co-design was viewed positively by participants as a way of creating more appropriate services and better engagement, thus potentially leading to reduced inequalities. Building relationships– with communities, individual community members, and with partner organisations– was critical for successful co-design and took time and effort. Short-term and unpredictable funding often hindered co-design efforts and could damage relationships with communities. Some commissioners raised concerns over the limited evidence for co-design, while others described having to embrace “a different way of thinking” when commissioning for co-design.ConclusionsCo-design is an increasingly popular approach to designing health in services but can be difficult to achieve within traditional funding and commissioning practices. Drawing on our case studies, we present key considerations for those wanting to co-design health services, noting the importance of building strong relationships, creating supportive organisational cultures, and developing the evidence base.

The drowning of ‘Lyonesse’: early legends of land submergence in southwest Britain and geoscience

ABSTRACT Stories about a submerged land named Lyonesse abound in culture traditions of Southwest Britain and plausibly derive from memories of land loss within the Scilly Isles. We review Lyonesse stories, their links to Arthurian romances and Greek/Roman accounts of the Cassiterides, and trace their divergent evolution. From this region’s history of land-sea movements and human occupation, we propose Lyonesse stories originated more than 4000 years ago when rising sea level divided a single inhabited island in the Scilly group. The comparable antiquity of similar stories is a compelling reason for supposing Lyonesse stories originated from observations of submergence encoded in cultural memories through oral traditions that endured in intelligible form for several millennia to reach us today.

Can computer simulation support strategic service planning? Modelling a large integrated mental health system on recovery from COVID-19

BackgroundCOVID-19 has had a significant impact on people’s mental health and mental health services. During the first year of the pandemic, existing demand was not fully met while new demand was generated, resulting in large numbers of people requiring support. To support mental health services to recover without being overwhelmed, it was important to know where services will experience increased pressure, and what strategies could be implemented to mitigate this.MethodsWe implemented a computer simulation model of patient flow through an integrated mental health service in Southwest England covering General Practice (GP), community-based ‘talking therapies’ (IAPT), acute hospital care, and specialist care settings. The model was calibrated on data from 1 April 2019 to 1 April 2021. Model parameters included patient demand, service-level length of stay, and probabilities of transitioning to other care settings. We used the model to compare ‘do nothing’ (baseline) scenarios to ‘what if’ (mitigation) scenarios, including increasing capacity and reducing length of stay, for two future demand trajectories from 1 April 2021 onwards.ResultsThe results from the simulation model suggest that, without mitigation, the impact of COVID-19 will be an increase in pressure on GP and specialist community based services by 50% and 50–100% respectively. Simulating the impact of possible mitigation strategies, results show that increasing capacity in lower-acuity services, such as GP, causes a shift in demand to other parts of the mental health system while decreasing length of stay in higher acuity services is insufficient to mitigate the impact of increased demand.ConclusionIn capturing the interrelation of patient flow related dynamics between various mental health care settings, we demonstrate the value of computer simulation for assessing the impact of interventions on system flow.

Integration of natural selection across the life cycle stabilizes a marine mussel hybrid zone.

Hybridization among related species is now recognized as common but it remains unclear how hybrid zones persist for prolonged periods. Here, we test the hypothesis that selection in different components of the life cycle may stabilize a hybrid zone. A hybrid zone occurs in southwest England between the marine mussels Mytilus edulis and M. galloprovincialis. Previous studies have found strong directional selection against alleles from M. edulis occurs among hybrids in the adult stage. Traditional hybrid zone models argue that alleles that are selected within the hybrid zone are replaced by migration from neighboring parental population into the hybrid zone. In this system, however, migration occurs out of this hybrid zone into neighboring parental populations. This hybrid zone should therefore be unstable and dissipate, yet this zone has persisted for more than 30 years. We tested and rejected the hypothesis that differences in fecundity may select for M. edulis alleles within this hybrid zone and thus counter the selection observed against these alleles among adults. We also tested the hypothesis that selection during the larval stage may counter selection against M. edulis alleles in the adult stage. We found that selection favors M. edulis alleles during the veliger stage of larval development. The direction and strength of selection during the larval stage are sufficient to counter strong selection during the adult portion of the life cycle. This hybrid zone is stabilized by opposing forms of directional selection operating in different portions of the life cycle.

Shared Space: promoting teachers’ academic understanding of inter-religious dialogue through a teacher fellowship model for religious education (RE)

We report on the design of a close-to-practice research project situated in Southwest England exploring the relationship between developing teachers’ ‘powerful knowledge’ of inter-religious dialogue in religious education (RE) through a teacher fellowship model for RE specialists, including a specialist curriculum development programme and co-constructed evaluation of an intervention seeking to promote ‘warmer’ community relations. This current phase of the ‘Shared Space’ project combines insight from two existing subject-specific knowledge exchange projects—undertaken by us—with a Teacher Fellowship approach to pedagogical and curriculum knowledge development pioneered by the Historical Association, and an emerging one, ‘After RE’. The current Shared Space project addresses two established concerns in RE that are not normally connected: (1) the lack of rigorous subject knowledge held by RE teachers in England; (2) the assumption that good RE in schools can promote community relations, a widely accepted assumption hitherto without much evidence to support it. Here we set out a justification for the project and the form it will take, based on established Shared Space principles of how best to support in-service teachers’ ongoing professional development through knowledge exchange with academics, mindful of equal power relations. While appreciating aspects of the notion of ‘powerful knowledge’ on which ‘theory-rich’ Teacher Fellowships have been based, we cite thinking from the emerging After RE project to suggest a modified theoretical framework for our investigation which will innovate methodologically when evaluating its impact in partnership with teacher participants.

Positive tipping points for the sustainable growth of bivalve shellfish mariculture in England and Wales

Shellfish mariculture, the farming of marine bivalve shellfish, is a highly sustainable form of food production, which contributes significantly to the rural, coastal economies of England and Wales, and has considerable potential for growth. To unlock this potential, we explored the application of the positive tipping points (PTP) framework in an invited stakeholder workshop comprising key policy makers, regulators, industry representatives and academic researchers. Stakeholders mapped environmental and socio-economic factors constraining shellfish mariculture and identified key opportunities (leverage points) for positive intervention. The workshop focused on five case studies from southwest England addressing key constraints identified for the shellfish industry, including “licencing”, “spatial planning” and/or “classification” of shellfish sites and cultured species. These case studies presented new data on the effectiveness of a range of interventions: i) catchment scale, and ii) nature-based, solutions for water quality management in the Exe estuary; iii) risk-based methods for assuring shellfish quality/safety in the Camel estuary; iv) evidence gathering on ecosystem services (habitat provisioning) by shellfish mariculture in Lyme Bay and, v) policy developments on licencing of Pacific oysters in England. Stakeholders highlighted opportunities for new guidance, innovative tools and technology to aid environmental monitoring, regulation and quality assurance for shellfish mariculture and for tradeable ecosystem services beyond food production (including nutrient regulation, coastal protection and habitat provisioning). These and other interventions identified by stakeholders (including product diversification and market development) were then prioritised and sequenced for optimal implementation. Actions, actors and enabling conditions were identified using the PTP framework to realise prioritised opportunities.

Embedding Owner-Manager Values in the Small and Medium Sized Enterprise Context: A Lockean Conceptualisation

The salience of owner-manager values to small and medium sized enterprise (SME) engagement with ethics and social responsibility is well documented. Despite this, understanding of how these values are transposed into and become embedded within the culture, norms and practices of SMEs remains limited. Through drawing on a sample of SMEs in the South West of England, this paper identifies the mechanisms which owner-managers seek to use to embed their values within their organisations—rational values sharing, affective values sharing and building values-aligned relationships—while distinguishing a number of barriers they meet in the process. It further builds on previous research and explicates such embedding processes by means of discerning and providing rich descriptions of eight key owner-manager values. The work of Alain Locke on values is drawn on theoretically to frame the embedding of such values as a reflexive, ongoing process, while the utility of his work—largely absent from the field of business ethics so far—is highlighted.

Measures of puberty in the Avon Longitudinal Study of Parents and Children (ALSPAC) offspring cohort

Background When studying the development of children through the preteen years into adolescence, it is often important to link features of their physical and mental health to the stage of puberty at the time. This is complex since individuals vary substantially in the ages at which they reach different pubertal milestones. Methods The Avon Longitudinal Study of Parents and Children (ALSPAC) is an ongoing longitudinal cohort study based in southwest England that recruited over 14000 women in pregnancy, with expected dates of delivery between April 1991 and December 1992. From 1999, information on puberty was collected using a number of different methods : (a) A series of annual questionnaires were administered when the index children were aged between eight and 17 years; these were mainly concerned with the physical changes associated with puberty; (b) identification of the age at peak height growth using the SITAR methodology; and (c) retrospective information from the girls on their age at onset of menstruation (menarche). Results The advantages and disadvantages of each method are discussed. Conclusions The data are available for analysis by interested researchers.

Bracing Ourselves: Embracing Policy Changes through a Long-Standing University–Schools Teacher Education Partnership in England

We articulate the principles behind our practices as teacher educators for an Initial Teacher Education (ITE) provider in South-West England working in partnership with local schools. We position them as ‘braces’ that enable us not only to withstand but ‘embrace’ the challenges of the current policy environment, which imposes braces of its own. All ITE providers in England must present their curriculum and teaching plans for approval by the Department for Education, one of many significant changes to ITE required in England over the last decade. Furthermore, for such plans to be approved they must assume a model of schooling based on knowledge acquisition in tension with not only our own motivations but also a broader (global) conversation among teacher educators critical of policy priorities for schooling and professional teacher formation that prioritise success in high-stakes tests and international league tables. The braces/principles emerge through articulating our collective understandings of and concerns with the policy braces. Our principles connect to the processes we feel confident are necessary aspects of ‘becoming’ teachers and can hold our Post Graduate Certificate in Education (PGCE) together, going forwards. The braces—becoming an informed educator; becoming an ethical actor; becoming a reflective practitioner—have a distinctive form of reflexivity at their heart and should apply to everyone across our partnership: us, as university-based teacher educators; school-based colleagues; and pre-service teachers. We offer our approach and the braces/principles we have developed to others also struggling to reconcile their own notions of good teacher education with national policy imperatives.

Improving uptake of population health management through scalable analysis of linked electronic health data.

Population Health Management - often abbreviated to PHM - is a relatively new approach for healthcare planning, requiring the application of analytical techniques to linked patient level data. Despite expectations for greater uptake of PHM, there is a deficit of available solutions to help health services embed it into routine use. This paper concerns the development, application and use of an interactive tool which can be linked to a healthcare system's data warehouse and employed to readily perform key PHM tasks such as population segmentation, risk stratification, and deriving various performance metrics and descriptive summaries. Developed through open-source code in a large healthcare system in South West England, and used by others around the country, this paper demonstrates the importance of a scalable, purpose-built solution for improving the uptake of PHM in health services.

Lessons from a research partnership in southwest England to understand community palliative care needs in rural, coastal and low-income communities.

The South West Peninsula (Cornwall, Devon, Somerset) has the highest proportion of over 65s (24.2%) and is the only English rural population with greater economic deprivation than in urban areas. Coastal populations have the worst health outcomes in England. Despite innovation among communities to support those with health and care needs in later life, recruitment to palliative care research in the region is low and there has been no evaluation of public health palliative care interventions. A new South West Peninsula Palliative Care Research Partnership was funded for 15 months, bringing together four universities, the voluntary and community sector (including hospices) and local National Institute for Health and Care Research networks. The aim was to establish a sustainable multisectoral partnership that would identify community-based support needs for underserved rural and coastal populations by: • conducting a literature scoping review on interventions to enable community members to support the dying; • delivering a research capacity-building programme; • co-creating public and patient involvement capacity; • determining the resources and needs for communities to support dying well; • integrating findings to develop a framework of community-based support and identify future research questions; • establishing a sustainable research network infrastructure for the long-term design and delivery of palliative care research. We convened partners to identify research needs and co-designed activities to meet our objectives. These included a scoping review; a capacity-building programme of training, seminars and a journal club; forming a patient and public involvement group; a multistranded community engagement programme using different creative approaches; four focus groups with members of the public and one with community workers; and producing three 'storytelling' audio recordings. Findings were presented to the partnership at a regional workshop. The scoping review showed that community-engaged palliative care interventions can improve outcomes for individuals but provided little evidence about which approaches work for different communities. Five online seminars and a quarterly journal club to develop research capacity were regularly attended by 15 to 25 participants from across the partnership. While evaluating our engagement methods was beyond the partnership's scope, levels of participation suggested that creative methods of engagement show potential to help researchers and practitioners better understand the needs and priorities of underserved populations. Data showed that rural, coastal and low-income communities face challenges in accessing end-of-life care and support due to issues such as transport to and distance from services, erosion of neighbourhood networks, isolation from family and friends, 'patchiness' of palliative care services and a lack of care providers. Community organisations are well-placed to co-produce and facilitate methodologies for involving communities in palliative care research. Although activities took place in diverse areas, it was not possible within the available resources to cover the entire large geographical region, particularly the most isolated rural areas. Partnerships bringing together voluntary and community sector organisations, palliative care providers, health and social care providers, individuals with experience and academics have potential to design future research and public health interventions that better understand local context, involving and supporting communities to address their needs at end of life. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR135312.

Through the Eyes of a Young Carer: A Photo Elicitation Study of Protective Resilience.

Caregiving is recognised as a source of stress with potential for negative health impacts as well as positive outcomes and development of resilience. For young carers, children, and adolescents providing care for close family members, adaptation through resilience is crucial, yet work using a resilience approach is limited. This study explored protective factors and pathways to resilience in a sample of young carers, through application of the socioecological model in caring relationships. An in-depth qualitative approach was used, with in-person interviews facilitated by auto-driven photo elicitation. Deductive thematic analysis was applied, framed by three levels (individual, community, and society) of the socioecological model of resilience. Twelve participants (nine girls and three boys) aged 5-18years, each providing care to a family member, were recruited using opportunity and volunteer sampling via carers' centres in the southwest of England. Ten key themes were identified, four at the individual level: pre-empting challenges and planning, cognitive strategies, emotional strategies, and seeking solitude; three at the community level: family support, friendships, and pets and inanimate objects; and three at the society level: professional support, access to caregiver activities and community, and being outdoors. The location of themes at each level indicated relevance of the socioecological model to identification of protective factors in a young carer population. These findings have important applications for guidance to charities and organisations supporting young carers. Identification of factors that promote resilience offers support for the development of well-informed interventions, which harness these protective factors to develop resilience and improve health for young carers.

Recent cluster of neonatal enteroviral myocarditis cases in the United Kingdom of Great Britain and Northern Ireland - current scenario and counteracting prospects

ObjectivesNeonatal myocarditis is a rare but life-threatening complication of enterovirus infection that presents like bacterial sepsis. OutbreakA sudden upsurge in cases of neonatal enteroviral myocarditis, reported from South West England and South Wales between June 2022 and April 2023 has alerted health agencies to bring in counteracting measures. ImpactIn view of this outbreak situation, the World Health Organisation advisory has urged clinicians seeing neonates and infants with shock may consider myocarditis as a differential diagnosis and test for enteroviruses.

13C dicarboxylic acid signatures indicate temporal shifts in catchment sediment sources in response to extreme winter rainfall

Rainfall and land-use interactions drive temporal shifts in suspended sediment sources, yet the magnitude of such changes remains poorly understood due to the lack of land-use specific source tracers. We investigated α,ω-dicarboxylic fatty acid root-specific biomarkers, as diagnostic tracers for apportioning sources of time-integrated suspended sediment samples collected from a grassland dominated agricultural catchment in the southwest of England during the wet winter period. Applying fatty acids-specific stable carbon isotope analysis and a Bayesian isotope mixing model, we show that stream banks contributed most of the sediment in the early winter, i.e. October–December, while winter cereal-dominated arable land contributed more than half of the sediment during the late winter, i.e. January–March. The dominant sediment source shifted in conjunction with a period of prolonged consecutive rainfall days in the later period suggesting that intervention required to mitigate soil erosion and sediment delivery should adapt to changing rainfall patterns. Our novel findings demonstrate that isotopic signatures of α,ω-dicarboxylic fatty acids are promising tracers for understanding the resistance of agricultural soils to water erosion and quantifying the interactive effects of extreme rainfall and land use on catchment sediment source dynamics.

Epidemiological impact of a large number of false negative SARS-CoV-2 test results in South West England during September and October 2021

During September and October 2021, a substantial number of Polymerase Chain Reaction (PCR) tests in England processed at a single laboratory were incorrectly reported as negative. We estimate the number of false negative test results issued and investigate the epidemiological impact of this incident. We estimate the number of COVID-19 cases that would have been reported had the sensitivity of the laboratory test procedure not dropped for the period 2 September to 12 October. In addition, by making comparisons between the most affected local areas and comparator populations, we estimate the number of additional infections, cases, hospitalisations and deaths that could have occurred as a result of increased transmission due to false negative test results.We estimate that around 39,000 tests may have been false negatives during this period and, as a direct result of this incident, the most affected areas in the South-West of England could have experienced between 6000 and 34,000 additional reportable cases, with a central estimate of around 24,000 additional reportable cases. Using modelled relationships between key variables, we estimate that this central estimate could have translated to approximately 55,000 additional infections.Each false negative likely led to around 1.5 additional infections. The incident is likely to have had a measurable impact on cases and infections in the affected areas in the South-West of England. Impact statementThese results indicate the significant negative impact of incorrect testing on COVID outcomes; and make a substantial contribution to understanding the impact of testing systems and the need to ensure high accuracy in testing and reporting of results.

Information needs of ethnically diverse, vaccine-hesitant parents during decision-making about the HPV vaccine for their adolescent child: a qualitative study

BackgroundThe English schools-based human papillomavirus (HPV) vaccination programme has the potential to eliminate HPV-related cancers if high uptake is achieved. However, unmet information needs among some parents may contribute to persisting lower uptake among minority ethnic groups. Through this study we aimed to understand the information needs of vaccine-hesitant, ethnically diverse parents during decision-making about the HPV vaccine for their adolescent child, to inform the future development of tailored communication materials.MethodsRecruitment was facilitated thorough healthcare and community organisations within London and the South West of England. Semi-structured interviews took place between April and August 2023. Thematic analysis was undertaken, assisted by NVivo software.ResultsOf the 29 parents interviewed, the majority were mothers (79%), belonged to a minority ethnic group (88%), and had an adolescent child unvaccinated against HPV (72%). Five of the interviews were undertaken in the participants’ primary language with translation support. Most parents interviewed had limited knowledge about the HPV vaccine and appeared conflicted as to whether vaccines could offer benefits to health. Misunderstanding around the potential of developing serious side-effects (e.g. fertility issues, developing cancer) were factors that could negatively impact decision-making by parents. Stigma associated with the sexual transmissibility of HPV did not always negatively impact decision-making. However, some parents chose not to vaccinate on the basis of perceptions of low risk and a preference to provide education about sexual behaviours to their adolescent child.ConclusionsTailoring communication materials to address misunderstandings could support informed decision-making by vaccine hesitant parents for their adolescent children to be vaccinated against HPV. Future communication materials about the HPV vaccine should highlight the benefits of protection against cancer to increase parents’ motivation for protect their adolescent child; provide accurate convincing information in relation to the excellent safety profile; and emphasise the importance of providing HPV vaccine at the recommended age, all alongside communicating the universality and commonality of HPV infection.Trial registrationN/A.

Timing of upland vegetation management affects breeding of three species of passerine birds: a case study from southwest England

ABSTRACT Capsule Current permitted timings of vegetation burning and Bracken Pteridium aquilinum control show considerable overlap with the timing of breeding of three widespread UK upland breeding passerine bird species on an upland site in southwest England. Aims To quantify the timing of breeding of Meadow Pipits Anthus pratensis, European Stonechats Saxicola rubicola, and Whinchats Saxicola rubetra and assess overlap with the permitted timing of the two widespread upland land management practices of burning and Bracken control on a moorland site in southwest England. Methods 498 nests were monitored across a 4.3 km2 area of Dartmoor between 2008 and 2014. The onset and timing of breeding activity, and variation between species and years, were quantified. Overlap between breeding activity and burning and Bracken control was then quantified for several realistic and legally permitted scenarios. Results There was considerable overlap between upland management practices and breeding activity of Stonechats, Meadow Pipits, and Whinchats. In all three permitted burning cessation scenarios (11, 13, and 15 weeks from 1 January) there was overlap with breeding activity of Stonechats and Meadow Pipits. The commencement of Bracken control in July also overlapped with breeding activity, with half of Whinchat nests and more than a quarter of Stonechat and Meadow Pipit nests potentially affected. Conclusion The overlap of timings for breeding and vegetation management is likely to be causing nest failure for a significant number of birds each year. We suggest a change to the permitted burning and Bracken control timings to better accommodate the protection of breeding passerine birds on Dartmoor.

Reproduction of Marphysa sanguinea Annelida, Polychaeta (Eunicidae), at Mount Edgecombe, Plymouth, near the type locality in Southwest England

Abstract The reproductive cycle of Marphysa sanguinea is described for a population at Mount Edgecombe, Plymouth, near the type location in Southwest England, using a data set obtained previously (October 1999 to September 2000). The species is iteroparous without schizogamy, spawning prior to October 1999 and during a short breeding season in 2000 from end August through September. The sexes are separate with a sex ratio of 1:1. Mature oocytes and spawned eggs are 215 μm in diameter and spermatozoa of the ectaqua sperm type. Mature gametes of both sexes are discharged through paired coelomoducts, and the diploid chromosome number is 28. Proliferation of new coelomic gametes from paired gonads began within a month of spawning and continued for 8–9 months but ovulation was suppressed in June and July. Attempts to undertake fertilisation using spawned oocytes and active spermatozoa were unsuccessful. The size of discharged oocytes suggests a short pelagic larval duration of a few days. This is the first publication about the reproduction of this species, and our results suggest that M. sanguinea is restricted to intertidal areas in SW England, NW France and southern North Sea. The highly synchronised pattern of reproduction observed is not compatible with a quasi-cosmopolitan species range indicating that this species has been mistakenly reported from around the world. Future studies of the genus should combine rigorous taxonomy with observations of reproduction to facilitate comparison among Marphysa spp.

A Multiple Case Study Exploring Person‐Centred Care in Care Homes

Background: There are 14,228 care homes in England with a population of approximately 372,035 residents, many of whom are living with frailty or multiple and complex comorbidities. Policy and international literature advocate that care homes provide high‐quality person‐centred care that meets each person’s specific needs. This study aims to provide an exploration of person‐centred care in care homes in the South West of England from the perspective of all those involved.Methods: A qualitative multiple case study design was used across seven care homes in a region of South West England. Semistructured interviews were conducted with 61 participants (residents, family and health and care professionals). Nonparticipant observations were undertaken in communal areas to understand the practices and cultures of the care homes. All data were analysed using reflexive thematic analysis.Findings: The findings are presented as six themes, they are adjusting to the transition into a care home; people at the centre of care; the place we call home with the people we call family; working across the boundaries of care; supporting, valuing and empowering care home teams; and managing complex and challenging moments of care.Conclusion: This study demonstrates a whole system understanding of person‐centred care across seven care homes. The main components of person‐centred care appear to be relational. These relationships take place in cultures and systems that are complex and challenging with care boundaries that need to be navigated. Navigating these care boundaries requires a people‐centred care approach built on partnerships and mutual respect.