UK Countries Research Articles

How long is long enough? An international survey exploring practice variations on the recommended duration of maintenance therapy with PARP inhibitors in patients with platinum sensitive recurrent ovarian cancer and long-term outcomes

ObjectiveThere are no data, and thus no consensus, on the optimal duration of poly(ADP-ribose) polymerase (PARP) inhibitor maintenance therapy for exceptional responders (here defined as progression-free for 5 years or...

School exclusion policies across the UK: convergence and divergence

ABSTRACT Previous comparative research has revealed recent high and rising school exclusion rates in England and a contrasting picture of much lower and reducing rates in Northern Ireland, Scotland and Wales. In this paper, we examine findings from new research into school exclusion policies across the four countries of the UK. This interrogates for the first time how the problem of ‘school exclusion’ is framed within these four distinct policy contexts. We take up the question of how policy levers and drivers may shape patterns and trends in permanent exclusion and suspension/temporary exclusion. This analysis reveals that, despite broad agreement in policy on a need to reduce exclusion and increase equity across the UK jurisdictions, there are diverging policy stances on the purposes of exclusion, responsibilities of schools and the role of the state overall in bringing about change. We conclude that deeper critical engagement with policy contexts is a vital element in understanding the persistence of school exclusion itself but also the differential rates of exclusion across the UK.

Age-specific all-cause mortality trends in the UK: Pre-pandemic increases and the complex impact of COVID-19

ObjectivesThis study aims to analyse age-specific all-cause mortality trends in the UK before and after COVID-19 emergence to determine if pre-pandemic trends contributed to increased mortality levels in the post-pandemic era. Study designStatistical analysis of UK mortality data. MethodsWe utilised age-structured population and mortality data for all UK countries from 2005 to 2023. Mortality rates were calculated for each age group, and excess mortality was estimated using the Office for National Statistics (ONS) method. ResultsOur most concerning finding is an increase in all-cause mortality rates for middle-aged adults (30–54 years) starting around 2012. The COVID-19 pandemic may have further impacted these rates, but the pre-existing upward trend suggests that current elevated mortality rates might have been reached regardless of the pandemic. This finding is more alarming than the slowdown in the decline of cardiovascular disease death rates for individuals under 75 noted by the British Heart Foundation. ConclusionOur results highlight the importance of considering both immediate pandemic impacts and long-term mortality trends in public health strategies. This underscores the need for targeted interventions and improved healthcare planning to address both ongoing and future challenges.

Owner satisfaction and prognosis for return to work after pancarpal arthrodesis in working dogs in the United Kingdom: a retrospective study (2011–2020)

BackgroundPancarpal arthrodesis (PCA) is a commonly performed procedure in the UK. However, it is not known whether working dogs in the UK and other European countries with carpal injuries that have undergone unilateral PCA are able to return to working ability as determined by the owner. Medical records from a referral hospital in the UK were reviewed retrospectively for cases of working dogs treated using unilateral PCA. Case files and radiographs were retrospectively analysed for cause of injury, diagnosis, and complications. The ability of the dog to work after surgery and owner satisfaction with the outcome were assessed using telephone questionnaire.Results50% (5/10, 50%) owners stated their dog could perform normal duties, 4/10 (40%) could perform most duties with some allowances. Outcome was not as good for dogs working on steep, uneven fell terrain. 80% (8/10, 80%) owners rated the level of post-operative lameness as unaffected with a normal gait. 90% (9/10, 90%) owners were either very satisfied or satisfied with the outcome of the procedure, and 90% owners stated the financial investment was worthwhile.ConclusionsUnilateral PCA carries a good prognosis for working dogs with high owner satisfaction. Caution should be advised for dogs expected to work on steep, uneven fell terrain.

Data as infrastructure: Systematic data curation addressing fundamental data content differences across the UK

Objective and ApproachHealth Data Research UK, the UK national institute for health data science, is coordinating efforts alongside national academic partners to streamline data curation at disease, population, and data structure level to enhance data offerings and provide networked data infrastructure supporting whole-UK research. Due to clinical, coding, and system differences across the constituent countries of the UK, data is often not standardised for whole-UK analyses, creating burden on research teams and leading to long data preparation times in order to run even distributed analyses. The approach to solve this is multi-faceted, including deploying data curation and cohort creation algorithms into health data providers’ environments, and through the novel integration of federated analytics solutions (such as those piloted through recent national infrastructure programmes) improving data access and research deployment efficiency. ResultsStandardising data through clinical and structural data curation directly deployed to health data providers creates a framework for whole-UK studies to be readily achievable, and provide the data infrastructure base to integrate new technical federated analytics solutions to deploy and reproduce analytics without unnecessary large scale data migration. Conclusions and ImplicationsSystematic curation of health data within national data providing organisations provides flexibility and choice for researchers in terms of the data they will apply for to answer vital research questions affecting the UK populace. Such advances will improve the quality and efficiency of research for all corners of the UK, and create a community of practice in terms of developing data from health systems to research environments.

Mortality from pulmonary hypertension in Europe 2001-2019

BackgroundThe incidence of Pulmonary Hypertension (PH) and Pulmonary Arterial Hypertension (PAH) is believed to be on the rise and is associated with poor outcomes.MethodsWe extracted age-standardized mortality rates (ASMRs) for decedents ≥ 18 years of age from the World Health Organization Mortality Database, using International Classification of Diseases 10th edition codes for PH and PAH, covering the period from 2001 to 2019. The UK and European Union countries with at least 1,000,000 inhabitants and at least 75% of available data points over the study period were included.ResultsBetween 2001 and 2019, in countries with available data, the median ASMR for PH increased by + 1.19 per 1,000,000 (+ 22.51%) in females and + 0.36 per 1,000,000 (+ 6.06%) in males. Out of 19 countries, 13 demonstrate an increase in female PH ASMR, and 12 reported an increase in male PH ASMR. In contrast, median PAH ASMR decreased by -0.29 per 1,000,000 (-28.74%) in females and remained relatively unchanged in males, with a minor increase of + 0.01 per 1,000,000 (+ 1.07%). Notably, there was significant inter-country heterogeneity, with countries such as Hungary, Romania, and Poland displaying results incongruous with the rest of Europe.ConclusionsWhile publicly available mortality statistics for PH may be unreliable, these data suggest an overall increase in mortality across Europe from 2001 to 2019. However, mortality from PAH has shown a decrease in females and a modest increase in males. This underscores the urgent need for robust and high-quality mortality reporting, including international registries, for both PH and PAH.

Designing social media to foster user engagement in challenging misinformation: a cross-cultural comparison between the UK and Arab countries

Challenging others who post misinformation is a type of social correction that complements algorithm-based approaches. However, participation rates in such social acts remain limited. In this paper, we study design techniques that leverage principles of persuasive system design and communication theories to foster such prosocial behaviour across two distinct cultural contexts: the British and the Arab. A total of 462 participants completed an online survey (250 UK, 212 Arabs). The study compared the two cultural contexts regarding willingness to challenge misinformation and the persuasiveness of seven design techniques to increase that willingness, namely predefined question stickers, thinking face reaction, sentence openers, fact checker badge, social norm messages, tone detector, and private commenting. Moreover, it explores the impact of individuals’ characteristics on their perception of the techniques as being more or less persuasive than a standard comment box. The study found that the willingness to challenge misinformation was significantly higher in the Arab context than in the UK context. Moreover, except for the private commenting, all techniques were more impactful in the Arab context than in the UK context. Some techniques, such as predefined question stickers, were more effective in both cultures compared to the standard comment box, while others, like the fact checker badge, were more effective only in the Arab context. However, in the UK, sentence openers had a lower impact. Furthermore, personality traits, age, and perspective-taking showed the potential but also the varying impacts on the persuasiveness of the techniques on users’ correction of misinformation across both cultural contexts while pointing to the need for considering both personal and cultural factors in designing social-correction-based solutions.

Synergistic state governance of labour standards in global value chains: Forced labour in the Malaysia–Nepal–UK medical gloves supply chain

Drawing on research into medical gloves global value chains (GVCs), this article examines the interacting roles that states differently positioned in GVCs have played in preventing and eliminating forced labour. Our case study, based on a worker survey and semi-structured interviews across GVC actors, focuses on forced labour in the Malaysian medical gloves sector during the COVID-19 pandemic, linking production in Malaysia, end markets in the UK (primarily through procurement for the National Health Service) and migrant-sending countries, especially Nepal. We analyze the intermeshing effects of the different roles of states, operating at either the horizontal or vertical level of GVC governance, in terms of contributing to issues of forced labour. We identify three state roles in the Malaysia–UK medical gloves chain: producer state (Malaysia), migrant-sending state (Nepal) and regulator-buyer state (UK). We also identify some of the most persistent barriers to resolving forced labour in the value chain. Our research illustrates that Malaysia’s complex regulatory, political and institutional dynamics most directly influence forced labour in gloves production, but Nepal’s migration policies and the UK’s healthcare procurement practices also create forced labour risk in Malaysia. Advancing Gereffi and Lee’s (2016: 25) notion of “synergistc governance” and Jessop’s (2016) strategic-relational approach (SRA) to the state, we thus argue that the creation of sustained and positive regulatory synergies among states differently positioned in GVCs is necessary for the prevention and elimination of forced labour.

THE IMPACT OF BREXIT ON THE PEACE PROCESS IN NORTHERN IRELAND

The article analyzes Brexit as a factor influencing the Good Friday Agreement and the transformation of the peace process in Northern Ireland, as well as the relationship between Northern Ireland and the Republic of Ireland. It is argued that Brexit poses a threat to the security of Ireland and the EU, since it undermines the foundations of the peace process in Northern Ireland and creates the likelihood that the border will be closed on the island of Ireland again. The Good Friday Agreement of 1998 was based on the fact that both signatory states are members of the EU, and many of its provisions will not be implemented after Brexit. It has been proven that after Brexit, the most controversial issue was the border between Northern Ireland and the Republic of Ireland, which became the external border of the EU. The border, which was heavily militarized during the conflict, became virtually invisible after its settlement, and people and goods freely cross it. This became possible largely because both Ireland and the UK were part of the EU single market, a common set of rules that ensures the free movement of goods, services, people and finances within the bloc.It is argued that the new relationship between the EU and the UK, which was agreed during 2020 and implemented from January 2021, resulted in an attempt to resolve the complex border issue, which was carried out in the Northern Ireland Protocol. The arrangements of the Northern Ireland Protocol, according to which Northern Ireland, but not the rest of the UK, remains within the framework of the EU single market for goods, make it possible to maintain an open border between Northern Ireland and the Republic of Ireland. The establishment of an open border was a key aspect of the Northern Ireland peace process and the 1998 Good Friday Agreement, which ended the conflict in Northern Ireland. It is shown that the Northern Ireland Protocol creates a de facto customs border in the Irish Sea between Northern Ireland and the United Kingdom. Mainly to address the concerns of the DUP unionists about the Northern Ireland Protocol, in 2022-2023, the EU and the UK agreed on revised mechanisms for its operation – the Windsor Framework, which entered into force on March 24, 2023. The DUP refused to accept the Framework Program as meeting their interests until early 2024. Further adjustments to its work have not been agreed upon and the formation of a new Northern Ireland executive has not begun. It is proved that Brexit is becoming a new and significant factor in the unification of Northern Ireland with the Republic of Ireland. Brexit has put the issue of the unification of Ireland at the top of the political agenda of both parts of Ireland. The majority of Northern Irish residents voted to remain in the EU in the 2016 UK referendum. Unification would give Northern Ireland, where both British and Irish citizens live, full EU citizenship.

Challenges for the management of Johne’s disease in the UK: Expectation management, space, ‘free riding’, and vet-farmer communication

Johne’s disease in cattle is a significant global animal health challenge. Johne’s disease is chronic, affecting the gastrointestinal tract of cattle and other ruminants and is caused by the bacteria Mycobacterium avium ssp. Paratuberculosis. Many countries have introduced schemes and programmes to try and control the spread of Johne’s disease, including the UK. Despite efforts to control it, however, Johne’s disease remains consistently ranked by UK producers as the top ranked disease negatively affecting productivity, indicating that schemes are not perceived to have solved the problem fully. Building on a global systematic review of the literature on barriers and solutions for Johne’s disease control on-farm, we conducted an empirical study with over 400 farmers and 150 veterinary professionals across the UK. The study used workshops and semi-structured interviews to understand better the challenges dairy farmers and veterinarians face in implementing on-farm Johne’s disease management schemes with the aim of identifying solutions. The study found that four main challenges are faced in the on-farm control of Johne’s – (1) Management of farmer expectations around Johne’s disease, with eradication near impossible, (2) Issues regarding space for segregation and the related economics of control (3) A ‘free-riding’ problem which can be influenced by the voluntary nature of control plans and (4) Challenges in vet-farmer communication, including levels of knowledge. Our findings have relevance for the control of Johne’s disease in the UK and other countries, including for regions with voluntary and compulsory control programmes.

The forest biodiversity index (FOBI): monitoring forest biodiversity potential over space and time

Public forest agencies are obligated to take steps to conserve and where possible enhance biodiversity, but they often lack information and tools that support and evidence their decision making. To help inform and monitor impact of management actions and policies aimed at improving forest biodiversity, we have co-developed a quantitative, transparent and repeatable approach for assessing the biodiversity potential of the United Kingdom’s (UK) publicly owned forests over space and time. The FOrest Biodiversity Index (FOBI) integrates several forest biodiversity indicators or ‘metrics’, which characterise management-sensitive woodland and landscape features associated with biodiversity. These are measured or modelled annually using spatially comprehensive forest survey data and other well-maintained spatial environmental datasets. Following metric normalisation and a correlation analysis, a statistically robust selection of these metrics is aggregated using a hierarchical procedure to provide composite index scores. The FOBI metric and index results are provided for every individual public forest, and can be summarised across any reporting region of interest. Compared to existing indicators that rely on sample-based forest data, the results thus better support decisions and obligations at a range of scales, from locally targeted action to national, long-term biodiversity monitoring and reporting. We set out how the FOBI approach and associated bespoke online interfaces were co-developed to meet public forest agency needs in two constituent countries of the UK (England and Scotland), whilst providing a conceptual framework that can be adapted and transferred to other geographic areas and private forests. Example results are reported for England’s public forests for four annual timestamps between 2014 and 2021, which indicate improvements to the biodiversity potential of public forests and surrounding landscapes over this time via increases in their diversity, extent, condition and connectivity.

Future temperature-related mortality in the UK under climate change scenarios: Impact of population ageing and bias-corrected climate projections

BackgroundExposure to heat and cold poses a serious threat to human health. In the UK, hotter summers, milder winters and an ageing population will shift how populations experience temperature-related health burdens. Estimating future burdens can provide insights on the drivers of temperature-related health effects and removing biases in temperature projections is an essential step to generating these estimates, however, the impact of various methods of correction is not well examined. MethodsWe conducted a detailed health impact assessment by estimating mortality attributable to temperature at a baseline period (2007–2018) and in future decades (2030s, 2050s and 2070s). Epidemiological exposure-response relationships were derived for all England regions and UK countries, to quantify cold and heat risk, and temperature thresholds where mortality increases. UK climate projections 2018 (UKCP18)were bias-corrected using three techniques: correcting for mean bias (shift or SH), variability (bias-correction or BC) and extreme values (quantile mapping or QM). These were applied in the health impact assessment, alongside consideration of population ageing and growth to estimate future temperature-related mortality. FindingsIn the absence of adaptation and assuming a high-end emissions scenario (RCP8.5), annual UK temperature-related mortality is projected to increase, with substantial differences in raw vs. calibrated projections for heat-related mortality, but smaller differences for cold-related mortality. The BC approach gave an estimated 29 deaths per 100,000 in the 2070s, compared with 50 per 100,000 using uncorrected future temperatures. We also found population ageing may exert a bigger impact on future mortality totals than the impact from future increases in temperature alone. Estimating future health burdens associated with heat and cold is an important step towards equipping decision-makers to deliver suitable care to the changing population. Correcting inherent biases in temperature projections can improve the accuracy of projected health burdens to support health protection measures and long-term resilience planning.

Health inequalities

Abstract There are marked differences in life expectancy between regions of England, between countries in the UK, and between the UK and other wealthy countries. In England, there are large differences in mortality rates between less and more educated adults, and between less and more deprived places. Austerity measures enacted after the financial crisis of 2008 not only harmed many people directly and unequally, through reductions in public services, but may also have played a role in the anaemic reduction in mortality rates observed for adults after 2010. Prescriptions on policy to improve the health of those left behind will need to wait for more and better data. It is not possible to understand the upstream mechanisms responsible for health outcomes using geographic indices of multiple deprivation. The most promising approach to improving population health is to continue to focus on the health and well-being of children.

Association of time spent on social media with youth cigarette smoking and e-cigarette use in the UK: a national longitudinal study

BackgroundSocial media may influence children and young people’s health behaviour, including cigarette and e-cigarette use.MethodsWe analysed data from participants aged 10–25 years in the UK Household Longitudinal Study 2015–2021. The...

21st century accelerating neurological deaths in UK and major Western countries: - Demographic and/or multiple-interactive-environmental causes?

ObjectiveWe examine whether the rise in neurological death rates over the 21st century are solely explained by the Gompertzian hypothesis. Study designWe examine two data-sets. First, Office of National Statistics (ONS, 2022) for nineteen mortality categories in England/Wales, including Alzheimer's, Dementias and Parkinson's Disease.Secondly, WHO (2020) Combined Neurological Mortality (CNM), from WHO Global mortality categories, Nervous Disease Deaths, and Alzheimer's & Other Dementias. MethodsBased on ONS data we investigate trends in Age-Standardised Mortality Rates (ASMR) of CNM 2000–2022.Based on WHO data we examine rates of Early Deaths (55–74) and ASMR, for CNM between 2000 and 2015 in the ten Major ‘Western’ economies: Australia, Canada, France, Germany, Italy, Japan, Netherlands, Spain, UK, and the USA. ResultsIn England & Wales death rates have increased 348% for Alzheimer's, 235% for Dementias, and 105% for Parkinson's Disease in contrast with falls in most other cause mortality.Early Adults Deaths CNM rates increased in eight countries, an average of 19%.Neurological ASMR rose in every country, averaging 43%, the highest was the UK 95%. ConclusionWe reject the Gompertzian hypothesis as an all-encompassing explanation for these marked increases in ASMR.Increases in early adult neurological deaths suggests this cannot be solely explained by an aging population. Furthermore, increases in mortality could be related to an increased prevalence of neurological conditions in this age group.Action is urgently needed to investigate factors - whether environmental, lifestyle or health systems - that could explain these findings.

The 3D response of a large-scale masonry arch bridge – Part II: Performance at failure

Masonry arch bridges continue to form a pivotal part of the transport networks of the UK and many other countries worldwide. However, their three-dimensional response (3D) under loading has to date been relatively little investigated. Here, details of a large-scale masonry arch bridge load tested to failure under laboratory conditions are presented. The bridge consisted of a brickwork arch barrel, abutments, spandrel walls, and compacted limestone as backfill material. Patch loading was applied to the surface of the backfill at the quarter and three-quarter span points to assess the failure mechanism, load-carrying capacity, and residual strength of the bridge. A range of sensors were employed to capture the 3D bridge response and ground-penetrating radar surveys were performed on both the virgin and load-tested bridge to compare its internal structure. The observed evolution of cracks and post-test deformed geometry demonstrated the presence of both a localised 3D mode of response in the arch barrel in the vicinity of the applied load and a global four-hinge mechanism. Failure-level load tests carried out first at the quarter span and then at the three-quarter span points showed that the load-carrying capacity of the bridge had reduced by only 10 % in the second test, though the stiffness of the bridge had decreased by around 35 %. During the failure-level load tests, significant in-plane and out-of-plane deformations of the spandrel walls were also observed, adding to the much smaller residual deformations recorded in low- and mid-level load tests.

The impact of excess body weight on employment outcomes: A systematic review of the evidence

BackgroundExcess body weight has been recognised as an important factor in influencing labour market outcomes. Several hypotheses explain the causal effect of excess body weight on employment outcomes, including productivity, labour supply, and discrimination. In this review, we provide a systematic synthesis of the evidence on the causal impact of excess body weight on labour market outcomes worldwide. MethodsWe searched Econ Lit, and Web of Science databases for relevant studies published from 1st Jan 2010–20 th Jan 2023. Studies were included if they were either longitudinal analysis, pooled cross-sectional or cross-sectional studies if they used instrumental variable methodology based on Mendelian Randomisation. Only studies with measures of body weight and employment outcomes were included. ResultsThe number of potentially relevant studies constituted 4321 hits. A total of 59 studies met the inclusion criteria and were qualitatively reviewed by the authors. Most of the included studies were conducted in the USA (N=18), followed by the UK (N=9), Germany (N=6), Finland (N=4), and non-EU countries (N=22). Evidence from the included studies suggests that the effect of excess weight differs by gender, ethnicity, country, and time period. White women with excess weight in the USA, the UK, Germany, Canada, and in the EU (multi-country analyses) are less likely to be employed, and when employed they face lower wages compared to normal weight counterparts. For men there is no effect of excess weight on employment outcomes or the magnitude of the effect is much smaller or even positive in some cases. ConclusionsThis review has shown that despite ample research on the relationship between excess weight and employment status and wages, robust causal evidence of the effects of excess weight on employment outcomes remains scarce and relies significantly on strong statistical and theoretical assumptions. Further research into these relationships outside of USA and Western Europe context is needed.

Northern Ireland and the United Kingdom Internal Market

Post-Brexit Northern Ireland occupies a unique position in the internal market of the United Kingdom due, primarily, to the Protocol on Ireland / Northern Ireland, or Windsor Framework. Agreed as part of the UK-EU Withdrawal Agreement, the Protocol/Windsor Framework provides that EU Single Market rules concerning the free movement of goods, customs, VAT, state aid and energy markets, continue to apply in Northern Ireland, despite it having formally left the EU along with the rest of the UK. To allow for the domestic implementation of the novel arrangements for post-Brexit Northern Ireland, set out in the Protocol/Windsor Framework, the UK Internal Market (UKIM) Act 2020 includes a series of specific provisions that except goods entering and leaving Northern Ireland from the ‘market access principles’ established by the UKIM Act 2020 in certain circumstances. This commentary introduces the UKIM Act 2020 then presents a review of its provisions that are specifically dedicated to post-Brexit Northern Ireland. Written in September 2023 the analysis then provides an assessment of the implications of measures agreed between the UK and EU laid down in the Windsor Framework texts which were published in February of this year. Based on the analysis of the UKIM Act 2020 set against the backdrop of the Protocol, then Windsor Framework, the commentary argues that the position of Northern Ireland post-Brexit is not only newly unique but also newly consequential for those both inside and outside its borders.

Net-Zero Heroes? Climate Change Mitigation Efforts and Strategies across Australian Group-of-Eight Universities

Businesses are increasingly declaring their operations to be “carbon neutral” or “net-zero”. But how real are these claims? We investigated the climate mitigation efforts of the eight leading universities in Australia and discovered that the actual emission reductions lag behind the net-zero rhetoric. In the last ten years, most universities increased energy consumption, while reported emissions plateaued. The energy consumption and greenhouse gas emissions of Group-of-Eight (Go8) universities were influenced by size and population growth, climate of the campus location, and energy efficiencies. The Go8 universities experienced, on average, a 25% increase in student numbers in the last decade, and most increased their energy consumption. However, Scope 1 (direct emissions) and Scope 2 (emissions from electricity consumption) remained stable for most universities from 2011 to 2019 and decreased on a per-capita basis, indicating some level of improved efficiencies. Almost all Go8 universities have net-zero commitments and aim to achieve this by similar measures: power purchase agreements (PPAs) for electricity consumption, and carbon offsets for remaining emissions. Most universities lack a strategy for direct or measurable targets regarding energy or emissions reductions along their value chain. Unlike the UK or other countries, Australia has no standardised emission reporting requirements for Scope 3 emissions (other indirect emissions). This has led to rudimentary and haphazard reporting, limiting comparability between universities. Only one university had a more complete Scope 3 inventory, and these Scope 3 emissions were five times greater than their combined Scope 1 and 2 emissions, indicating a potential for substantial under-reporting of emissions. This highlights the need for more rigorous, consistent, and sector-specific emissions accounting, especially on indirect emissions, and for an overhaul of net-zero accreditation.

Improving hospital-based opioid substitution therapy (iHOST): protocol for a mixed-methods evaluation

Background Opioid substitution therapy is associated with improved health and social outcomes for people who use heroin and other illicit opioids. It is typically managed in the community and is not always continued when people are admitted to hospital. This causes opioid withdrawal, discharge against medical advice, and increased costs. We are establishing a project called iHOST (improving hospital opioid substitution therapy) to address these problems. This is an applied health research project in which we will develop and evaluate an intervention that aims to improve opioid substitution therapy in three acute hospitals in England. The intervention was developed in collaboration with stakeholders including people who use opioids, hospital staff, and other professionals who work with this group. It includes five components: (1) a card that patients can use to help hospital clinicians confirm their opioid substitution therapy, (2) a helpline for patients and staff, (3) an online training module for staff, (4) a clinical guideline for managing opioid withdrawal in hospital, and (5) ‘champion’ roles at each hospital. Methods We will do a mixed-methods study including a quasi-experimental quantitative study and a qualitative process evaluation. The primary outcomes for the quantitative study are discharge against medical advice and emergency readmission within 28 days. We will do a difference-in-difference analysis comparing changes in these outcomes for patients at iHOST sites with changes for patients at control hospitals. The process evaluation will use in-depth interviews, focus groups, and site observations with people who use opioids and staff. We will assess acceptability of the intervention, barriers and facilitators to implementation, and contextual factors impacting outcomes. Impact We anticipate that iHOST will improve care for hospital patients who use illicit opioids and/or are receiving community-based opioid substitution therapy. Depending on the results, we will promote the intervention at hospitals across the UK. Dissemination, including through publication, will inform hospital-based services for people who use drugs both in the UK and other countries.