Aims: (1) To explore how social prescribing referrals impact experiences of existing members of a voluntary and community-based organisation and (2) to describe the processes and relationships associated with joining community and voluntary organisations. Methods: Online survey and qualitative interviews with members of Men’s Sheds, a global volunteer-led initiative to address loneliness and social isolation in men. 93 self-selecting Shed members (average age 67 years, 93% male) from across England and Scotland took part in the survey about demographics, joining the Shed, and free-text questions about experiences in the Shed. From the survey participants, 21 Shed members were purposively sampled and interviewed to explore the impact of social prescribing and referrals on the Sheds. Results: Participating in the Men’s Shed was often associated with a significant change in personal circumstances, and Sheds provided a unique social support space, particularly valuable for men. Key factors around experiences of social prescribing and referral mechanisms were identified. We developed three themes: the experience of joining a Shed, success factors and risks of social prescribing, and ‘we care but we’re not carers’. Conclusions: The results show that Men’s Sheds are a caring organisation, but their members are not trained as professional carers, and men come to the Shed for their own personal reasons. They are concerned about the potential additional responsibilities associated with formal referrals. They encourage the development of relationships and local-level understanding of the essence of Sheds to enable social prescribing. As models of social prescribing grow nationally and internationally, collaboratively working with voluntary and community organisations to develop a mutually beneficial approach is essential for the effectiveness and sustainability of social prescribing in community health.

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The COVID-19 pandemic and associated 'lockdowns' profoundly impacted people's lives in 2020-2021 and beyond. This study sought to understand unique person-centred insights into health and wellbeing during the restrictive measures in the United Kingdom and to enable us to remember and give testimony to these lived experiences. Using photo-methods, participants from a larger cohort study which tracked people's behaviours during the pandemic were invited to share photographs and short text to visually illustrate their ephemeral and unique COVID-19 experiences. In total 197 participants shared 398 photographs. Using a critical realist approach in our design and analysis, we sought to gain an alternative viewpoint on what 'lockdown' and the pandemic meant. Our major findings revealed starkly contrasting experiences illustrated in our two major themes. Firstly loss, including ambiguous losses and a sense of loss, loss of freedoms and death. Secondly, salutogenesis (what makes us well) whereby participants were able to draw on assets which helped to keep them well by maintaining social connection, 'making the best of it', reconnecting with nature and appreciating the outdoors, creativity for pleasure and faith. Our findings illuminate widely differing experiences and indicate the powerful effect of assets that were perceived by our participants to protect their wellbeing. Understanding differential vulnerability will be essential going forward to target resources appropriately to those who have the least control over their lives, those with the greatest vulnerabilities and least assets which in turn could support a self-perpetuating recovery.

Aims To determine patterns of universal and secondary healthcare use in children seriously or fatally harmed from maltreatment in England Methods The authors analysed recorded use (and lack of use) of universal and secondary healthcare for children subject to a serious case review (SCR) in England 2005–2007. SCRs occur when a child ≤17 years dies or is seriously harmed, maltreatment is (suspected to be) a factor, and there are lessons for interagency working. Our purposive sample (N=40) was regionally representative and similar (in ethnicity, gender and type of incident) to all SCRs in England 2005–2007 (N=189). The authors used standardised templates and multiple layered readings to extract data from the 40 SCR overview reports. Results Two-thirds of children were ≤5 years at the time of the incident (toi) (N=26/40) Half (N=20) were boys. Seventy per cent died (N=28/40) and 30% were seriously harmed. Eighty percent of children (N=32/40) were recorded as using/being registered with ≥1 universal care service, of which a third (N=10) had full recorded use of all age-relevant universal care (antenatal care, vaccinations, general practitioner registration, health visitor/midwife/school nurse); 28% (N=9/32) only had recorded contact with a midwife/health visitor/school nurse; and 40% (N=13/32) had missed appointments. Two-thirds (N=25/40) had ≥1 of the following recorded: known chronic conditions (N=16); secondary care follow-up (N=21); admission (N=12). Four out of five families were known to children's social care (CSC) (N=31/40), of whom a third (N=10/31) had no recorded health problems/admissions or secondary healthcare. Six children (15%) were not recorded as known to either CSC or secondary healthcare, of whom three were young babies and two older teenagers. There was much missing data. Conclusion Primary care services, particularly midwives, health visitors and school nurses, were important for these children but missed appointments were common. Chronic conditions and/or secondary healthcare were common and CSC knew most of these families. SCRs cannot assess unmet healthcare needs because of poor quality data. Data linkage between SCRs and healthcare databases would improve understanding of the contribution of health to the care of children who die or are seriously harmed and would release professional time for reflection about the case.

STUDY OBJECTIVE To describe the economics of UK school breakfast clubs, to estimate costs resulting from clubs and to investigate relationships between costs and outcomes. DESIGN A postal survey of schools with a 1-year follow-up, a cluster randomized controlled trial, case studies, semi-structured interviews with parents and a secondary econometric analysis. SETTING England, the UK. MAIN RESULTS Key economic differences were identified between clubs based in primary schools and those based in secondary schools in terms of both funding levels and cost structures. However, funding levels were not a significant determinant of the observed outcomes in either type of school. CONCLUSIONS For formal economic evaluation to succeed during implementation of a new initiative, a clearer understanding of relevant outcomes and the distinction between short- and long-term outcomes and potential individual, institutional and societal benefits are required from an early stage.

STUDY OBJECTIVE:To measure the health, educational and social impacts of breakfast club provision in schools serving deprived areas across England.DESIGN:A cluster randomized controlled trial and an observational analysis.SETTING:England, the UK.INTERVENTION:funding to establish a school-based breakfast club vs. control (no funding).MAIN RESULTS:Intention to treat analysis showed improved concentration (Trail Making Test Part A) amongst the intervention group at 3 months. Fewer pupils within the intervention group reported having skipped classes within the last month and fewer pupils within the intervention group reported having skipped 1 or more days of school within the last month at 1 year. Observational analysis at 1 year showed a higher proportion of primary-aged breakfast club attendees reported eating fruit for breakfast in comparison to non-attendees. A higher proportion of breakfast club attendees had borderline or abnormal conduct and total difficulties scores (primary-aged pupils) and prosocial score (secondary-aged pupils).CONCLUSIONS:Analyses revealed a mixed picture of benefit and apparent disbenefit. This study illustrated the challenges of evaluating a complex intervention in which the evaluators had less control than is usual in randomized trials over recruitment, eligibility checking and implementation. If the impact of new policy initiatives is to be assessed using the most robust forms of evaluation, social policy needs to be organized so that evaluations can be constructed as experiments. This is likely to prove most difficult where the perceived value of implementing an intervention rapidly is high.

Lack of breakfast has been implicated as a factor contributing to children's poor diets and school performance. Breakfast-club schemes, where children are provided with breakfast in school at the start of the school day, have been initiated by the Department of Health in schools throughout England, UK. The aim of the present study was to compare the energy and nutrient intakes of schoolchildren who attended breakfast clubs (attendee subjects) with those who did not (control subjects). Three different schools were studied, involving a total of 111 children aged between 9 and 15 years. There were fifty-nine attendee and fifty-two control subjects. The two groups were matched for eligibility for school meals. All subjects completed a 3 d weighed food diary for estimation of nutrient intake. Height and weight were measured and BMI calculated. Nutrient intake data were analysed using a general linear model with age as a covariate. The demographic and anthropometric characteristics of the attendee and control subjects were similar. Children who attended breakfast clubs had significantly greater intakes of fat (% energy), saturated fat (% energy) and Na than control subjects. Thus, in these schools breakfast-club participation was not associated with superior nutrient intake or improvements in dietary pattern.

# 1. WHAT DO THE PUBLIC THINK ABOUT THE USE OF THEIR HEALTH INFORMATION? PATIENT ELECTRONIC RECORD: INFORMATION AND CONSENT—THE PERIC PROJECT {#article-title-2} 3921 adults randomly selected from across Great Britain were interviewed. Subjects were asked to assess a selection of 10 out of 200