BACKGROUND: Innovations, especially those involving digital technologies, are expanding rapidly in health and social care in many countries around the world, but the extent to which the needs of underserved populations are considered is unclear. The aim of this study was to explore if and how socioeconomic health inequalities are considered in the design and delivery of health and social care innovations in the United Kingdom. METHODS: A qualitative study using 23 semi-structured interviews with a range of stakeholders involved in the development and delivery of innovations in health and social care in England and Scotland exploring 20 areas of innovation. Data were analysed thematically. RESULTS: Of 20 innovation areas, only one explicitly focused on reducing health inequalities for people living in deprived areas. The remaining broadly fell into three groups: (1) ‘Aspirational intent’ where stakeholders hoped their work would benefit people living in deprived areas but active planning was not involved; (2) ‘Stymied intent’ where stakeholders were aware of health inequalities but faced systemic and structural constraints that limited their opportunities to tailor innovations to the needs of deprived populations; and (3) ‘No intent’ where stakeholders (over half of those interviewed) were apparently unaware or indifferent to health inequalities. The lack of consideration for innovations utilising digital technologies holds particular risks for widening health inequalities. Two additional cross-cutting themes - ‘The influence of funding’, and ‘The role of the third sector’ - were identified. Stakeholders reported including a focus on health inequalities when funders explicitly prioritised it. Conversely, a lack of funding significantly hindered stakeholders’ abilities to address health inequalities. The involvement and contribution of the third sector in tackling or mitigating the effects of health inequalities was commonly reported as an under-utilised and under-funded resource. CONCLUSIONS: Our study suggests that socioeconomic health inequalities are seldom explicitly considered in the funding, design, delivery, policy translation and implementation of service innovations. Present innovation trajectories therefore risk widening rather than narrowing health inequalities, especially for digitally-based innovations.

BACKGROUND:Social prescribing connects NHS patients to activities, groups, and services in their community to address wider health determinants. Those living with disability may have needs for support from social prescribing, yet there is little evidence exploring this. METHODS:We examined the association between referral to social prescribing and disability, using logistic regression in 5578 individuals aged ≥50 from wave 10 of the English Longitudinal Study of Ageing (year 2021-23). RESULTS:Referral to social prescribing is significantly associated with mobility disability (OR 1.68 [95% CI: 1.26-2.23]), Instrumental Activities of Daily Living disability (1.56 [1.16-2.09]) and basic Activities of Daily Living disability (1.39 [1.03-1.86]). Our results suggest that this is driven by referrals for: (i) participants at the earlier stages of disability (i.e. with difficulty climbing stairs (1.49 [1.13-1.97]), walking ¼ mile unaided (1.83 [1.37-2.44]), and doing [heavy] housework (1.47 [1.08-1.98]), (ii) participants with difficulty managing money (1.85 [1.06-3.08]), and (iii) those with difficulty dressing (1.47 [1.08-1.99]) or using the toilet (1.72 [1.12-2.59]). CONCLUSIONS:Older adults at either end of the disability spectrum are referred to social prescribing. Further research is needed to understand whether this is meeting needs, and if benefits vary with the level or nature of the disability.

Introduction Promoting physical activity among disadvantaged groups is a major policy goal in many high-income countries. We aimed to summarise evidence on the effectiveness of population-level interventions to promote physical activity among socioeconomically disadvantaged groups. Methods A rapid systematic review was undertaken. Searches were conducted in four bibliographic databases in April 2025 (2015–2025) and grey literature, with additional forward citation searching and checking reference lists of relevant reviews. Studies were included if they: evaluated population-level approaches to promoting physical activity in adult populations; compared effectiveness between socioeconomic groups and were published in English from any country. Studies were quality assessed and a narrative synthesis applied. Results 12 studies (13 publications) were included. Studies were rated moderate (n=3) and low (n=9) in quality. A programme of free access to gym and swim facilities with supplementary health promotion (UK) and a community-wide health promotion programme targeting older adults (Japan) were successful in promoting physical activity among disadvantaged groups while posing a low risk of widening health inequalities. Other interventions identified either did not increase physical activity in disadvantaged groups or posed a high risk of widening health inequalities. Conclusion Some population-level approaches are promising, but ongoing monitoring of how these approaches work across different contexts is crucial. Hidden costs must be mitigated against to maximise the benefits of population approaches for the most disadvantaged. There has been modest progress in incorporating equity considerations into evaluations of population-level interventions to promote physical activity. PROSPERO registration number CRD420251032624.

BACKGROUND:Most people live with and die from multiple long-term conditions. In the last year of life, many receive burdensome care of limited benefit, while access to palliative care remains inconsistent. Improving care for this population would help address inequity because disadvantaged groups are disproportionately affected. AIM:To examine professionals' perspectives on palliative care needs and end-of-life challenges for people with multiple long-term conditions and their families, and to identify implications for service design and organisation. DESIGN:Semi-structured interviews were analysed using cross-case comparison within reflexive thematic analysis. SETTING/PARTICIPANTS:Twenty-seven multidisciplinary professionals and decision-makers from health and social care in England were purposively sampled to include strategic and operational perspectives across specialities. RESULTS:Three themes explored cumulative complexity, crisis-driven care and lack of ownership. Interacting conditions created complexity was unaddressed by disease-focused services, contributing to fragmented care and coordination burden. Care was reactive, with emergency responses and unplanned transitions associated with limited anticipatory planning. Responsibility for coordinating support was often unclear across service boundaries. Contributory factors included resource pressures, limited community workforce capacity and poor communication between services. Suggested service features included proactive review prompted by indicators of rising risk or deterioration, holistic multidisciplinary assessment with a relational, individualised approach to advance care planning, shared records and key worker roles. CONCLUSIONS:Current service organisation does not consistently meet palliative care needs in advanced multiple long-term conditions. Earlier risk recognition, clearer coordination responsibility and integrated multidisciplinary community provision are key priorities for improving care quality, sustainability and equity.

INTRODUCTION:Spiritual health is an important component of holistic health and social care provision; however, previous research highlights a training gap in this area. The SHARP (Spiritual Health Awareness and Recommendations in Primary Care) project used co-design processes informed by the Person-Based Approach (PBA) to develop a training intervention to address this gap. This paper evaluates the process of using co-design within this sensitive, stigmatised topic area that faces challenges in terms of language, identity, power and strongly held values-based opinions. METHODS:Five co-design workshops were held with a diverse mix of participants including GPs, social prescribers, primary care staff, chaplains, carers, patients and members of the public. Data sources included workshop transcripts, observer notes and post-workshop participant surveys. Thematic analysis was conducted deductively in line with a co-design evaluation framework, where we considered people-level outcomes within and without the co-design group, process outcomes and system-level and sustainment outcomes. RESULTS AND ANALYSIS:Thirty-eight participants took part in the workshops. Analysis identified co-design outcomes at people, group, research process and system-level. Participants valued having space to express views on a sensitive and often taboo topic, with 'being heard' functioning as a prerequisite for engagement and reported high levels of engagement. Professional hierarchies and outsider status persisted despite conscious facilitation efforts, while pragmatic design choices shaped participation, continuity and collective action. The professional mix of participants supported whole-team thinking about implementation, although recruitment of motivated participants may have limited the identification of additional barriers to change. CONCLUSION:The SHARP project provides important lessons on the use of co-design in sensitive and value-laden research topics. Specifically, for researchers to be attentive to participants' need to be heard, active management of power and hierarchy, and explicit negotiation of pragmatic constraints. Mixed-group co-design can support whole-team thinking about implementation, while reflexive awareness of who is included remains critical to understanding what barriers may be surfaced or missed. PATIENT AND PUBLIC CONTRIBUTION:Patients, carers and members of the public were actively involved in the design, conduct and interpretation of this study. Public contributors and people with lived experience of primary care were recruited as equal participants within the co-design workshops alongside clinicians and other stakeholders, where they contributed to discussions, activities and decision-making that shaped the content, format and implementation considerations of the SHARP training intervention. Patient and public contributors also informed interpretation of findings through their reflections on workshop processes and perceived relevance to patient care. In addition, members of an established patient and public involvement group were consulted prior to and following the co-design process to advise on acceptability, burden on primary care services and communication of the intervention to patients and the public. Their feedback directly informed refinement of the intervention and dissemination materials.

Background: The UK aimed to prolong the working lives of women by introduced a policy raising women’s state pension age (SPA) from 60 to 66. The impact of involuntary prolonged employment on individual’s health and well-being is debated. We explore how the well-being, mental and physical health of the women impacted by the policy has been affected. Methods: We used data from the first 12-waves of the longitudinal Understanding Society survey dataset. Using heterogeneous difference-in-difference models with regression adjustment we compared the outcomes of cohort of women affected by the policy born in financial years 1950/51-1955/56 to those unaffected by the policy born in 1949/50. Findings: Our sample consisted of 16,251 observations across 1,832 women. Women impacted by the policy experienced better well-being and mental functionality, compared to those unaffected by the policy. This impact was significant specifically for the 1952/53 and 1953/54 cohorts and for women in professional and managerial occupations. The policy did not impact physical functionality. A robustness check using an unaffected male sample showed no such impact. Interpretation: Women impacted by the SPA increase appeared to have better well-being and mental functionality compared to women not affected by the policy. Trends in impacts appeared similar across sub-groups defined by job type. Limited statistical power for the sub-group analysis meant findings should be interpreted with caution.

INTRODUCTION:Care homes play a significant role in caring for older adults at the end of their lives. Residents often have multiple long-term conditions (MLTC), complex care needs, and unpredictable health trajectories. This makes the delivery of effective palliative care difficult and may leave residents' needs inadequately addressed. METHODS:This systematic review aimed to narratively synthesise evidence on the palliative care needs of care home residents with MLTC, and the care models available to meet these needs. Two review protocols were registered with PROSPERO (CRD42024512220/CRD42024510220), and five databases searched to identify relevant studies (MEDLINE, Embase, Scopus, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)). Retrieved articles were merged and independently double-screened. Included articles were evaluated for quality and risk of bias. RESULTS:18 studies met the inclusion criteria. The main findings were categorised into four groups: (1) complex and unpredictable health trajectories; (2) residents' significant physical, functional and emotional needs; (3) inadequate and inequitable access to palliative care; and (4) a limited number of existing and proposed models of care. CONCLUSION:Residents in care homes with MLTC have complex palliative care needs. A limited number of palliative care models exist; however, access is currently insufficient and inequitable and their evidence base requires expansion.

Physical activity is important for healthy ageing, yet participation is socially patterned and often lower among older adults experiencing disadvantage. This rapid systematic review updates and extends previous evidence by examining differential effectiveness of individual-level physical activity interventions in older adults at differing levels of advantage/disadvantage, and experiences of engaging in interventions. Rapid review followed Cochrane guidance and PRISMA-Equity reporting. MEDLINE, Embase, CINAHL Plus and grey literature were searched for studies published from 2015 to November 2024 in high-income countries. Eligible studies (randomised, non-randomised and qualitative designs) evaluated individual-level interventions to promote physical activity or reduce sedentary behaviour among adults aged ≥ 50 years. Disadvantage and marginalisation were operationalised using PROGRESS-Plus. Data were synthesised narratively by population group, disadvantage characteristic and intervention type. Where possible, random-effects meta-analyses were conducted using MET-minutes. Risk of bias was assessed using adapted Mixed Methods Appraisal Tool, and certainty of evidence using GRADE. Forty-seven studies were included (n = 9071 participants). Only six studies examined differential effects between disadvantaged and more advantaged groups, and evidence was low or very low certainty. There was low-certainty evidence that behavioural interventions increase physical activity similarly for women and men, but evidence was insufficient for conclusions by education, marital status or race/ethnicity/culture. Evidence of moderate certainty suggests that physical activity, educational, and multicomponent interventions can increase physical activity in individuals from minoritised ethnic groups. Evidence on the effectiveness of multicomponent interventions in women is of moderate certainty, but findings are mixed. Evidence for interventions with individuals of low socioeconomic status or living in rural areas was of very low certainty. We found no studies with other disadvantaged/marginalised groups. Qualitative findings highlight that barriers and enablers to physical activity are similar across disadvantaged/marginalised groups. Evidence remains insufficient to determine whether individual-level physical activity interventions are equitable across disadvantaged and more advantaged older adults. Targeted community-based interventions for minoritised ethnic groups show promise, but broader evidence gaps persist. Future evaluations should routinely collect and report PROGRESS-Plus characteristics, assess differential effects, address intersectional disadvantage, and use standardised physical activity outcomes to inform equitable policy and practice.

Abstract Background The gap in Disability-Free Life Expectancy between affluent and deprived areas of England is stark, at over 15 years. Successive governments have recognised the need to narrow this and extend the years of life spent without disability, but there is little evidence outlining how large an intervention must be to achieve meaningful gains. This study examines intervention scenarios to (i) extend Disability-Free Life Expectancy and (ii) reduce socioeconomic inequalities in Disability-Free Life Expectancy, among older people in England. Methods We applied multistate modelling to longitudinal data on 16 899 individuals, aged 50 + in England, incorporating disability data from three cohort studies: the English Longitudinal Study of Ageing, the Cognitive Function and Ageing Study II, and the Newcastle 85 + Study. Simulations assessed how reducing the risk of disability associated with age and area-based socioeconomic deprivation could extend Disability-Free Life Expectancy. In these simulations, deprivation-targeted interventions reduced the excess disability risk and differential recovery observed in people living in the 20% most deprived areas. Age-targeted interventions reduced the age-related increase in disability risk and the corresponding decline in recovery. Results Interventions targeted solely at the most deprived quintile yielded modest Disability-Free Life Expectancy gains (up to 2.8 years for women and 2.3 years for men, in deprived areas only). Interventions targeting age-related disability risk alone were associated with increases in Disability-Free Life Expectancy of 6.3 to 8.7 years under a 40% reduction in age-related disability risk, but exacerbated the gap between the most and least deprived populations. Interventions addressing both age- and deprivation-associated risks demonstrated the greatest potential. A 30% decrease in the age-based probability of disability, and commensurate increases in recovery from disability, alongside removal of deprivation-associated inequalities, increased Disability-Free Life Expectancy by 4.8 to 8.6 years for men and women aged 50, with women living in deprived areas benefiting most. Conclusions Extending Disability-Free Life Expectancy while reducing socioeconomic inequality is difficult, but possible by tackling both age- and deprivation-related risks. Taken on their own, age-based interventions risk increasing inequalities, as they disproportionately benefit people living in less deprived areas.

Background Physical activity interventions targeting frailty improve health in later life. Integrating these interventions with primary care services may enhance perceptions and outcomes of delivery. Every Move Matters (EMM) is an 8-week group-based frailty intervention aimed at improving physical ability, social connection, and wellbeing. Recruitment is embedded within primary care pathways. EMM is delivered by external partners within or near general practice venues. Aim To explore the experiences and perceptions of participants, intervention providers, and primary care staff involved in delivering the EMM frailty intervention, with a focus on the impact of its co-location within or near general practice settings. Design & setting A rapid inductive qualitative evaluation of the EMM intervention co-located with primary care services. Method Semi-structured interviews were conducted with nine EMM attendees, six primary care staff, and three staff members from the activity provider organisation between October 2023 and March 2024. Transcripts were analysed thematically. Results Three themes were developed: straightforward implementation and adaptation; effectiveness; and buoyant atmosphere. EMM’s location within primary care reassured attendees and fostered enthusiasm and support from primary care staff, promoting recruitment and feelings of pride. A dedicated embedded postholder with access to patient records could enhance recruitment. Conclusion Implementing co-located interventions in collaboration with primary care is possible and has benefits for intervention attendees, delivery staff, and primary care practitioners. The potential to embed other interventions within primary care settings could be explored. Closer collaboration with primary care may promote access to data for evaluation of the longer-term benefits and sustainability of a range of interventions.

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

Introduction Polypharmacy is often managed at home by older people and those involved in their day-to-day care. Home care workers are well placed to play a crucial role, but there is little research in this setting. This study aimed to explore experiences and perceptions of polypharmacy amongst providers of home care.Methods We conducted qualitative interviews with 15 home care staff from five for-profit home care providers in three regions of England. Data were analysed thematically.Results We identified three overarching themes: (1) managing medications within a fragmented care system, (2) decision-making and autonomy and (3) client and family expectations and emotional burden of home care work. People providing home care services were striving to support older people with medications with limited training, communication or authority. The emotional toll on the home care workers was considerable.Conclusion Home care supports an ageing population to live and be cared for, close to home. There are potential benefits to the management of polypharmacy, of better integrating home care into the broader health and care system. Clarity over roles, appropriate channels of communication and enhanced training are required.Patient or Public Contribution Individuals with lived experience of home care services contributed meaningfully throughout the study. They advised on the development of the topic guide to ensure that interview questions were relevant, acceptable and reflective of real-world home care experiences. At the mid-point of data collection, public contributors reviewed insights and provided feedback on whether additional issues or perspectives should be explored in subsequent interviews. Following completion of data collection, they were also involved in discussing the preliminary findings and ensuring that the interpretation accurately reflected the experiences of those using and or accessing the service.

Abstract Background Advance care planning helps people plan for and communicate preferences about future care, including when decision-making capacity is lost. For people living with advanced multiple long-term conditions, advance care planning is challenging because decline may be unrecognised, responsibility is diffused across condition-specific services, and care is fragmented. Aim To explore health and social care professionals’ perspectives on challenges and best practices in advance care planning for people with advanced multiple long-term conditions, and to generate recommendations for improving practice. Methods Reflexive thematic analysis of advance care planning-related interview data from a wider study examining palliative care needs and end-of-life challenges for people with multiple long-term conditions. Twenty-seven semi-structured interviews were undertaken with health and social care professionals, commissioners, and service managers in four regions of England. Results Three themes were generated: (1) Making multiple long-term conditions decline visible – cumulative illness burden and social adversity contributed to late recognition of deterioration; (2) System and organisational barriers – resource constraints, fragmented care, poor information sharing, and limited training created unclear ownership of advance care planning, with particular risks for people experiencing inequity; (3) Delivering advance care planning – effective advance care planning was introduced early, revisited iteratively, grounded in trusting relationships, and included families and care networks. Conclusions For advanced multiple long-term conditions, advance care planning is undermined by prognostic uncertainty, care fragmentation, and inequities. Embedding prompted, iterative advance care planning into routine care, using markers such as functional decline and escalating support needs, may normalise conversations and support earlier documentation of preferences. This analysis extends needs-focused work by specifying practical mechanisms to initiate, share ownership of, and sustain advance care planning across fragmented services.

Purpose Mandatory digital social care records and a standardised schedule for collecting information on home care clients are proposed for regulated adult social care providers in England. This could facilitate the introduction of a minimum data set (MDS). This study aimed to understand current data collection practices in home care, and identify where support for implementation of an MDS is needed. Design/methodology/approach An online survey of English home care providers was conducted in 2023, asking about the information they collect, store and share about their clients. Data were analysed using descriptive statistics and logistic regression. Findings One hundred and fifty five responses were received from home care providers in all regions of England, a majority were for-profit organisations (89%). All collected a range of data on client characteristics and observations about care delivered. Monitoring of changes in client wellbeing and use of standardised measurement tools (e.g. functioning, mood or quality of life) were uncommon. Over two-thirds (71%) reported that they reviewed the content of care packages at least every six months. Providers with a majority of self-funding clients were more likely to regularly update information on care needs and client/ family preferences. Practical implications Data collection in UK home care will require expansion, to implement an MDS, which has resource implications for providers. Home care staff will need the skills to collect and use data to enhance client care. Originality/value To the best of the authors’ knowledge, this is the first national survey of home care providers on their routine data collection practices.

Background:General practice provides first-line National Health Service care for around 400,000 care home residents. Good primary care can enhance residents' health and well-being and optimise use of hospital services. Objectives:This study aimed to explore the relationships between organisation of general practice and the perspectives and experiences of residents, general practice and care home staff, outcomes and costs. Design:Survey of general practices (2018), qualitative study (2019), analysis of primary care data (2019-21). Policy context:National Health Service England Vanguard funded innovation in services for care homes in five areas (2015-8); Enhanced Health in Care Homes introduces standardised care home healthcare processes in England (2020-4). Setting:England: national survey; qualitative work in three areas (two Vanguards); analysis of national primary care data across early implementation of Enhanced Health in Care Homes and the COVID-19 pandemic. Participants:One hundred and fifty general practice survey respondents; 101 interviewees (general practitioners, practice managers, receptionists, care home managers, nurses, senior carers, residents, relatives, commissioners) in three areas; 103,732 care home residents ≥ 75 years, registered with participating practices in Clinical Research Datalink Aurum 2019-21. Results:Qualitative analysis identified three themes concerned with general practitioner services to care homes: relational processes, communication and organisation. Continuity of care, sensitivity to the skills of care home staff and routines of the home, along with a willingness to dedicate time to patients, are all crucial. Different structures (e.g. scheduled visits) provide opportunities to develop effective, efficient care, but flounder without established, trusting relationships. The way in which new initiatives are implemented is crucial to acceptance and ultimate success: telemedicine was an example that generated efficiencies for the National Health Service, but could be a burden to care homes, resented by staff and perceived as a barrier to overcome. One hundred and fifty practices responded to our survey, a majority staffed by ≤ 5 general practitioners. Larger practices were more likely to have a nominated general practitioner for care homes and make weekly scheduled visits. Analysis of primary care data found that in practices with a higher number of care home residents, patients had more contacts with primary care and fewer urgent referrals. Between 2019 and 2021, total contacts and estimated costs increased, and urgent referrals and polypharmacy fell. Limitations:Sparse evidence of systematic change in Vanguard areas limited our conclusions about specific initiatives. Implementation of national policy during the COVID-19 pandemic complicates data interpretation. Conclusions:Larger practices or those with higher numbers of care home residents were more likely to adopt ways of working that are associated with higher-quality care. However, trusting relationships between care homes and a motivated, adequately resourced primary care workforce may be more important than models of care, in enhancing primary care for care homes. General practices and care homes find creative ways around initiatives that are not perceived to offer any benefits, emphasising the need for local flexibility when implementing national initiatives. Future work:Future work could address how best to promote ways of working that prioritise trusting relationships; the absence of care pathways specific to care home patients, and the impact of Enhanced Health in Care Homes on system-wide costs. Funding:This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 14/196/05) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 11. See the NIHR Funding and Awards website for further award information.

Social prescribing aims to provide holistic care to patients beyond that offered in consultations with clinical health professionals. Support may be directed at many aspects of health and well-being, including spiritual health. Spiritual health is known to be associated with many other physical, mental and rehabilitation health outcomes. How social prescribers define and understand ‘spiritual health’ is unknown. In this survey, we aim to explore what UK social prescribers understand by the term “spiritual health.” We asked social prescribers: ‘what does spiritual health mean to you?’ Responses were analysed using descriptive statistics. Free text data were subject to deductive thematic analysis using a priori themes from the literature on definitions of spiritual health. One hundred and seventy-one social prescribing link workers participated; 153 gave a definition of spiritual health. Twice as many participants described themselves as spiritual than described themselves as religious. Definitions of spiritual health fell into three themes: 1. A sense of self, peace, meaning and purpose; 2. Connections to others, the world, or a deity; 3. Spiritual or religious practice. Spiritual health appears to be a term with meaning to UK social prescribers, distinct from religiosity. Use of this ‘working definition’ of spiritual health will allow further research into how spiritual health fits within social prescribing in the UK to move forwards.

Introduction Health and care data are routinely collected about care home residents in England, yet there is no way to collate these data to inform benchmarking and improvement. The Developing research resources And minimum data set for Care Homes' Adoption and use study has developed a prototype minimum data set (MDS) for piloting. Methods and analysis A mixed-methods longitudinal pilot study will be conducted in 60 care homes (approximately 960 residents) in 3 regions of England, using resident data from cloud-based digital care home records at two-time points. These will be linked to resident and care home level data held within routine National Health Service and social care data sets. Two rounds of focus groups with care home staff (n=8-10 per region) and additional interviews with external stakeholders (n=3 per region) will explore implementation and the perceived utility of the MDS. Data will be assessed for completeness and timeliness of completion. Descriptive statistics, including percentage floor and ceiling effects, will establish data quality. For validated scales, construct validity will be assessed by hypothesis testing and exploratory factor analysis will establish structural validity. Internal consistency will be established using Cronbach's alpha. Longitudinal analysis of the pilot data will demonstrate the value of the MDS to each region. Qualitative data will be analysed inductively using thematic analysis to understand the complexities of implementing an MDS in care homes for older people. Ethics and dissemination The study has received ethical approval from the London Queen's Square Research Ethics Committee (22/LO/0250). Informed consent is required for participation. Findings will be disseminated to: academics working on data use and integration in social care, care sector organisations, policy makers and commissioners. Findings will be published in peer-reviewed journals. Partner NIHR Applied Research Collaborations, the National Care Forum and the British Geriatrics Society will disseminate policy briefs.

Early in the COVID-19 pandemic, care homes (long-term care facilities) globally were severely impacted in many ways, including end-of-life care and death of residents. They experienced significantly elevated mortality rates amongst residents, compounded by restrictions on support from external healthcare and specialist palliative care providers. Family access to dying residents was often severely restricted. This paper explores experiences of deaths, dying and end-of-life care in care homes during the first year of the pandemic (Spring 2020–2021). As part of a wider study of experiences in care homes in Northern England during the early pandemic, we conducted semi-structured interviews with care home staff (16), residents (3), family members (5) and health service staff (10). Interviews were analysed using reflexive thematic analysis, this secondary analysis focusing on experiences of death and dying over the period. Thematic analysis generated three key themes: (1) Preparing for large scale deaths: Care home staff reported a sense of foreboding at requirements to prepare for large scale resident deaths, sometimes feeling left with minimal external support to manage this, and uneasy about the rapid roll-out of emergency care planning to residents; (2) Balancing support and policing visiting during the terminal phase: The requirement to restrict access for family members when their relatives were dying was experienced as distressing for both family members and care home staff; and, (3) Distress surrounding deaths for staff and families: Care home staff were distressed by the frequency and speed of deaths that they witnessed when their care home had a COVID-19 outbreak. Family separation near time of death was a source of distress for everyone involved, with suggestions that this led to regrets in bereavement for family members, and moral distress in staff. The experience of death and dying in care homes in the early waves of the COVID-19 pandemic was extremely challenging for care home staff and family members. Our analysis suggests that the ramifications of stringent visitation policies and the consequent distress may shape experiences in bereavement. Monitoring for longer term consequences, such as prolonged grief and moral injury, should be a priority.