20/124 HS&DR Commissioning brief: Adult Community Health and Social Care services to avoid planned and unplanned hospital admissions
Closing date: 08 April 2021 (two stage – Stage 1 to Stage 2)
An evidence review conducted by NICE  identified a need for further research to understand the role of community health and social care services in helping to reduce the number of planned and unplanned admissions to emergency care that are potentially avoidable. Community health and social care services (CHSCS) have a long history of delivering care closer to and in the home and are especially important in supporting those at risk of admission to secondary care. But CHSCS are under increasing pressure to meet growing demand from people living with increasing frailty and more people living with multiple long-term conditions.
Recent policy reforms, such as the NHS Long Term Plan  also identified CHSCS as being important in avoiding emergency, planned and other unplanned hospital admissions, encouraging greater use of community-based services and a series of reforms and restructuring of services, such as the development of sustainable transformation partnerships, integrated care systems and pilot vanguard sites.
As adults being cared for in the community have increasingly complex needs the shape and skill mix of the workforce is also adapting to meet these needs, this has led to a rise in the needs for certain professions in the community e.g. occupational therapy and physiotherapy . Meanwhile, the majority of care continues to be provided by nursing professionals  whose workloads are being increased to meet demand both in terms of scope and the amount of care service users require. In spite of this, amongst community nursing professions the Queen’s Nursing Institute (QNI) estimates that the number of District Nurses has declined by 43% in England in the last 10 years .
Consequently, there is a need for research to understand how CHSCS are adapting to the changing needs of people needing services in the community and how the workforce can be optimally deployed to provide effective and timely care. These changes should also support other parts of the health and care system, by avoiding hospital admissions and enabling earlier discharge from hospital settings, supporting people to manage their health and remain in their homes.
The focus of this call is on the organisation and delivery of adult community health and social care services, and its role in avoiding planned and unplanned hospital admissions. In the context of this call, community health and social care services are services delivered at an individual level to help people manage their health and care needs in a person’s home. Examples might include, but are not limited to, the provision of palliative care, domiciliary care and acute care following a stay in hospital. Typically, these services are overseen by a care professional but often involve a multidisciplinary team which may involve professions such as community and district nurses, healthcare support workers, allied health professionals (AHPs) and social workers.
Applicants should provide a careful justification of the importance of the proposed research and how it will complement the existing evidence base without duplication or overlapping with ongoing research. All applications should explain the potential impact their research will have on community health and social care services.
The following issues are of interest, though other issues may be proposed.
- How is the rising demand for services influencing their delivery and is it affecting the outcomes of community health and care services? What technologies and innovative approaches have been shown to or are likely to support the efficient and effective delivery of community health and social care services?
- Have different models of service or care been adopted for people in their homes in rural compared to urban settings? If so, how do they differ and what is the impact on patients, family, staff, community and wider health and care services. How can their characteristics inform best practice?
- What are the barriers and enablers to implementing more integrated care models in community health and social care services? How can these inform the design of services across a range of settings and service users?
- What models of delivering adult community health and social care have been shown to be cost effective in avoiding emergency, planned or unplanned hospital admissions? And how do services ensure their sustainability over time?
- How can the skill mix of the workforce be optimised to meet current and future demands for services and provide effective and timely care for people in the community?
- Which professionals are best placed to co-ordinate and be curators of care?
Applications to this call should demonstrate how they will address issues of health inequality and underserved members of the community. The findings of the research should be widely applicable and the research should be conducted across a representative range of community participants.
The programme is also interested in receiving applications for a systematic evidence review of published and grey literature, to update a previous 2014 review by the University of York Centre for Reviews and Dissemination (6);
- To identify any new evidence of the effects and key characteristics of interventions intended to reduce unplanned hospital admissions for people living in care home settings.
Applicants interested in undertaking the evidence review will need to complete a single straight to stage 2 application form which is not accessible via the ‘Apply Now’ button in the main call advert. Please contact firstname.lastname@example.org quoting ‘Community Care – evidence review’ for information about how to apply.
Research proposals should be co-produced with national organisations and professional bodies, health and social care service professionals, and service users. Links with health and social care planners and professional bodies is encouraged to facilitate the impact and scaling up of research findings to benefit the wider health and social care system.
The COVID-19 outbreak is having a significant impact across the Health and Social Care System. As this research may be conducted during the COVID-19 response and recovery stage, the research should consider how the impact of COVID-19 response and recovery may affect your ability to conduct your research.
The NIHR is committed to actively and openly supporting and promoting equality, diversity and inclusion (EDI). All NIHR applications need to demonstrate they have met the requirements of the Equality Act (2010) by embedding EDI throughout the research proposal, ensuring there is no discrimination across the following domains; age; disability; race, including colour, nationality, ethnic or national origin; religion or belief; sex; sexual orientation; gender reassignment; being married or in a civil partnership; being pregnant or on maternity leave. Applicants are expected to pay attention to populations that have been underserved, to carry out research in locations where the need is greatest, and to promote the inclusion of diverse participants.
The NIHR Health Services and Delivery Research (HSDR) programme supports applied research with the aim of improving health and social care services across the nation. In order to enhance the success of a proposal a clear theory of change and pathway to impact with links into the NHS and social care delivery process is suggested. It is useful to consider in your study design how outcomes could be scaled up to maximise impact and value for money across the NHS and social care– the focus is on applied research with tangible impacts on systems that improve the quality, accessibility and organisation of health and social care services. This also includes stakeholder engagement and the development of processes, tools and guidelines to strengthen workforce capacity. Further general information about the Health Services and Delivery Research programme can be found here.
The programme is open to any methodology which is appropriate to answer the proposed research question. This must be fully explained and justified.
Further information on the background to this call and relevant research is given in the call supporting information document.
- NICE. NICE Guidance [NG94]. Emergency and acute medical care in over 16s: services delivery and organisation. 2018. Available Online. Accessed August 2020.
- NHS England. NHS Long Term Plan. 2019. Available Online. Accessed May 2020.
- NHS England. NHS Workforce Statistics - June 2020. 2020. Available Online. Accessed August 2020.
- NHS Benchmarking Network. Community Services benchmarking deep dive report for Community Integrated Care teams (CICTs). 2020. Available Online. Accessed August 2020.
- The Queen’s Nursing Institute. Outstanding Models of District Nursing: A joint project identifying what makes an outstanding District Nursing Service. 2019. Available Online. Accessed August 2020.
- Centre for Reviews and Dissemination. Interventions to reduce unplanned admissions from care home settings. University of York. Evidence briefings. 2014. Available Online.