Groups that experience the worst health outcomes include people in coastal communities (like in the North East and North Cumbria), experiencing homelessness, dependent on drugs or alcohol, vulnerable migrants, people in contact with the justice system and other socially excluded groups. In the North East, 32% of people live in the most deprived 20% of the national population. The recent Levelling up White paper (2022), the White paper on health and social care integration (2022) and the NHS's Core20PLUS5 framework (2022) all highlight the role of housing as a key determinant of health. This consortium will investigate and co-produce integrated, community led, asset-based approaches to supporting people with multiple and complex needs who have been homeless, to improve individual and community wellbeing and address health disparities in the North East North Cumbria Integrated Care System (NENC ICS). The project will: (1) Provide training for and work closely with a group of Experts by Experience (who have been homeless), who will support evidence development and decision making into practice, policy and research in this area. They will: share their experiences and views on how services might best support people with multiple and complex needs; make use of an 'innovation budget' to improve a service and evaluate their innovations; help with mapping existing services. They will be an integral part of the project, leading many aspects of it. (2) Identify all the research evidence in the area of community support for people who experience homelessness, and identify the data being held by relevant stakeholders (local authorities, health services, voluntary sector) and how it might be shared to gain a better understanding of regional needs and monitor progress. (3) Identify one integrated care service (integrating, health, social care and housing), which will be improved and evaluated by experts by experience. (4) Identify and map all local community assets and services supporting people with multiple and complex needs, particularly in relation to housing, in the NENC. The mapping will create a directory of all services, statutory or otherwise, which community members can access for support. This will form the basis of a digital dynamic data sharing platform accessed by all relevant stakeholders, which will become a virtual consortium, directly connecting research on community assets with health and social care integration efforts, and community members, to reduce health disparities. For this bid we have brought together an interdisciplinary team of experts across academia (covering expertise in housing; health inequalities; humanities; health economics; mental health; addictions; participatory research), service (housing; NHS) and policy (ICS) partners. The project is supported by Tyne Housing, a third sector organisation working with people experiencing precarious housing and homelessness; the NIHR NENC Applied Research Collaboration (a a partnership bringing together six regional universities, the NHS, health and social care providers, local authorities, the voluntary sector, community groups and members of the public); and the NENC Deep End network (a network of GP surgeries working in the most deprived areas regionally).

This study has been prompted by the shift to non-face-to-face - remote - forms of working in patient public involvement and engagement (PPIE) brought on by Covid-19 prevention measures (such as social distancing). Working remotely includes using digital technologies such as: online conferencing software (Zoom, Microsoft Teams), emails, telephone calls and social media (WhatsApp, Facebook). Due to measures such as shielding and social distancing the usual ways of involving the public in research that included face-to-face meetings and events are not possible, and even with the eventual easing of lockdown, remote working is likely to continue. This creates particular challenges for ensuring access and engagement from all parts of society in health and social care research. There is a well-documented digital divide between those who use or have access to digital technologies and those who do not. This digital divide reflects the existing socio-economic inequalities, and PPIE that takes place remotely has the potential to further exclude already disadvantaged groups. This project aims to facilitate and improve ways of doing PPIE remotely and increase the diversity of public contributors involved in health and social care research. Our objectives are to: 1. Understand the barriers and facilitators to remote working, by: a. Exploring public contributors and PPIE professionals' experiences of remote PPIE. b. Exploring public contributors' preferences for different types of remote working. 2. Develop mechanisms for implementing improvements in remote working and ways to increase diversity in PPIE by: a. Conducting a rapid review of research and 'how to guides'. b. Develop training packages. We will recruit public contributors involved in research projects across the UK: the NIHR, charities, universities and other research organisations and people involved professionally with PPIE. This is a mixed-methods study with: surveys, qualitative interviews, and a discrete choice experiment. We will produce an analysis of how remote working in PPIE is affected by socio-economic and health inequalities, make recommendations for improving practice and develop training packages.

Seen as an almost fatal disease half a century ago, cancer has become a treatable disease for many, with a growing proportion of cancer patients living for more than five years after a diagnosis. Recent estimates suggest that there are now 2 million people living past a diagnosis of cancer in UK and over half of these have had breast, colorectal or prostate cancer. As the five-year survival rates for all cancers combined has reached 50%, the long-term effects of cancer and its treatments, both physical and psychological, are becoming more relevant. While many people surviving at least 5 years from diagnosis report few or no problems, 20-30% report physical problems, poorer quality of life, psychological distress, sexual problems, problems with social relationships and financial concerns. Although there is an enormous range of resources available to people with cancer, most are aimed at supporting people through the diagnosis and active treatment phases. There has been relatively little research, and few resources, to help survivors to deal with life beyond the active treatment phase. Our research with cancer survivors demonstrates the need for internet resources to support the growing number of people living with cancer long-term. The proposed project will follow on from a Cancer Research UK funded study about the use of primary care services and unmet needs of long-term cancer survivors. As part of that research, 40 people who had survived at least 5 years from diagnosis of breast, colorectal or prostate cancer were interviewed about what it is like to live beyond cancer. The interview study was conducted using qualitative methods developed by a group of social scientists in the Health experiences research group Oxford that have been developed and refined over 10 years and based on rigorous social science research methodology. These data will be combined with interview recordings from long-term survivors of other types of cancer who participated in previous HTO studies, and re-analysed for the purpose of writing 20-25 summaries for HTO on the issues that are most important to cancer survivors. The topic summaries will be illustrated with clips from the interviews in video, audio or text format. The topic summaries will be drafted by the researcher, checked by another researcher who will familiarise themselves with all the data, and by an appropriately qualified member of an expert advisory panel. The panel will include cancer survivors, social scientists and health and social care professionals. The researcher will identify, in consultation with the advisory panel, a list of respected national and local organisations and websites that provide other kinds of information and support, for inclusion on the site. Before our project partners, DIPEx, publish the material on the HTO website we offer a couple of pilot focus groups to ensure that the new site reflects the experiences of cancer survivors and that we have correctly identified the issues that are important to a broader range of cancer survivors than those included in the original interview sample. Audio tape recorded focus group interviews would be conducted with long-term cancer survivors and used to identify unmet information and support needs. Participants would then be invited to explore the 'draft' website and complete a brief questionnaire which would cover whether the site addressed their unmet needs, whether the issues that they think are important were covered, whether perspectives akin to their own had been covered in the topic summaries, if they had learnt anything new and whether they would recommend the site to others. The new section of HTO on living beyond cancer will be intended primarily as a resource for other people who are living beyond cancer, their family and friends, and will also be used to educate health and social care professionals.

When teenagers get a good night's sleep, they are more likely to be able to concentrate, regulate their emotions and behaviours, problem-solve, learn and succeed at school, and avoid difficulties with anxiety and depression. Teenagers are naturally vulnerable to problems with sleep, because of multiple biological, psychological, and social changes. Although some teenagers will be lucky to avoid problems with their sleep, up to two thirds do not receive the recommended 8-10 hours sleep. Furthermore, many teenagers experience several unpleasant consequences of this lack of sleep. For some young people, the experience of disturbed sleep as a teenager can lead to long-term difficulties with mental health, particularly depression. Experiencing depression is not uncommon during the teenage years, with an estimated 154,000 10-19 year olds meeting diagnostic criteria for depression. Difficulties with depression can lead to difficulties at school and with friendships, as well as commonly presenting with self-harm and suicidal behaviours. Negative thinking patterns, or 'cognitions', have long been theorised to play a key role in the maintenance of various mental health problems, triggering unhelpful cycles of behaviour as well as causing distress. There is evidence that this may be the case for both insomnia and depression. There is also preliminary evidence that negative cognitions may explain why sleep problems can lead to depression, with it being theorised that sleep-specific cognitions can trigger more generalised negative thoughts about the world. Psychological treatments for sleep problems have been found to improve both sleep and mood in adults and young people, and adult psychological models of insomnia propose that these treatments help generate positive and helpful thoughts about sleep, which may generalise to positive and helpful thoughts more broadly. However, this has rarely been tested, and it is not currently known if this theory can be applied to depression or teenagers. We would like to find out: The proposed research uses an intervention design to better understand 1) how sleep and depression are linked in teenagers, 2) why improving sleep can also reduce depression, and 3) whether negative thoughts about sleep can be changed and interrupt other negative thoughts. Workshops using evidence-based techniques for improving sleep will be delivered in schools by external mental health practitioners. Workshop content will include how to create a good sleep environment and setting optimal bedtimes and waketimes as well as follow-up sessions to check in and help problem-solve. Sleep, mood and cognition will be measured pre- and post-intervention, and at a follow-up, to measure change. The study design will also allow us to examine whether offering sleep interventions in schools could improve both sleep and depression, and whether it is a scalable solution that should be tested and evaluated on a larger scale. Why this matters: This research is important because it will help us to understand how and why teenagers' sleep is crucially linked to their mood and wellbeing. The findings will provide evidence of how best to support teenagers to improve their sleep quality and quantity, with potential short- and long-term improvements in their wellbeing. To ensure that the research has long-term benefits for society, the work is being conducted within one of the recently provisioned services providing school-based mental health support, meaning that it could be scaled up nationally. The research has the potential to dramatically affect the way that schools and parents can support young people's wellbeing and to significantly decrease problems with sleep and depression as a consequence. This would improve the quality of life of teenagers across the UK and decrease the substantial societal costs associated with long-term mental health problems.

In the UK, four out of five adults suffer from back pain at some point in their life, the treatment of which costs the NHS over a billion per year and the UK economy £10 billion per year. When a surgical option is required (for example after an accident or because of abnormalities in the spine), the gold standard is spinal fusion, an invasive intervention designed to stop the motion of the affected spinal area. One of the main issues with spinal fusion is that it increases the stress on other area in the spine, in particular on small cartilaginous joints called the facets. Even in a healthy person, the facets are often deteriorated but this rarely cause any symptoms. After spinal fusion however, the deterioration can increase and create new symptoms and long term pain for one in four patients. There is an urgent need to define the type of patients and procedures for which fusion works best; and to improve devices so that this accelerated deterioration of the facets happens less often. The levels of initial deterioration between patients differs greatly and there is currently a lack of biomechanical evidence that takes into account these large variations when testing fusion devices. To tackle these issues, this grant will develop novel testing methods and tools combining laboratory simulation with computer modelling. These methods will be used to predict the variation in the mechanical performance of a series of parameters in fusion devices at various levels of facet deterioration. This will enable the different interventions to be matched to different patient's characteristics. In addition, the process of proving the accuracy of the testing methods will involve conducting tests at different levels of deterioration. The results from these tests will provide a greater understanding of how facet deterioration affects the biomechanical function of the spine. This knowledge will have the potential to inform the development of other more effective treatments for the spine and the new methods developed can also be applied to other joints in the body.