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21/50 - National Evaluation of NHS @home specification document

 

Contents

Specification document for 21/50 National Evaluation of NHS @home
Closing date: 1pm, 03 August 2021

Scope

The Health Services and Delivery Research (HS&DR) Programme is interested in receiving applications for high quality and timely research to evaluate the effectiveness and implementation of NHS @home as an approach to providing care in people’s own homes and increasing self-monitoring and management for people. A principal focus of the evaluation is the proactive care programme for different long-term conditions with potential for future @home activities to come on stream. More detail on current areas of the programme in scope for this national evaluation are provided in the supporting information. The main aim is to deliver a substantive evaluation of the NHS @home model and approach, preferably by a single team or syndicate, with some flexibility in what components are assessed. The final scope will be negotiated with team[s] and the Programme, working closely with NHS England and Improvement. This evaluation will complement and build on other local and targeted evaluation underway. 

Please note this is a single stage assessment process and guidance to applicants needs to be carefully followed.  

Background

NHS @home is a nationally-led programme of work aimed at providing better connected, more personalised care in people’s homes including care homes.  It aims to ensure people have faster access to more appropriate, targeted, and personalised care, without necessarily having to attend emergency care or GP appointments. 

NHS @home has supported the response to the pandemic through personalised care for people at home, supporting early and safe discharge as well as avoiding unnecessary admissions, attendances, or appointments. This has included cross-organisational work distributing blood pressure monitors and leading work to support systems to rapidly implement COVID Oximetry @home and COVID Virtual Ward models during the pandemic, which was a key part of the NHS’s response to COVID and can help reduce mortality from silent hypoxia, ensure timely treatment, and potentially free up critical care beds. The COVID Oximetry @home model was recently evaluated by the NIHR Rapid Evaluation Centres (The Birmingham, RAND and Cambridge Evaluation (BRACE) Centre Team and Rapid Service Evaluation Research Team (RSET).

NHS @home has now been established as longer-term programme and will include work to expand @home and virtual ward models of care for patients with long-term conditions whilst supporting systems to ensure that COVID remote monitoring pathways are ready to be scaled up quickly if necessary. Further details on the scope of the different sub-programmes within the NHS @home are included in the supporting information document.

The NHS @home programme builds upon the learning from COVID-19 pandemic, maximising the use of technology to support more people to better self-manage their health and care at home.  It aims to provide more convenient, high quality and timely alternatives to face-to-face care, where this works for the individual, and when clinically appropriate.  It also aims to support delivery of the NHS Long Term Plan commitments to give people more control of their health and more personalised care when they need it and aligns with the Universal Personalised Care: Implementing the Comprehensive Model, particularly supported self-management, shared decision making and personalised care and support planning.

There is a particular focus on health inequalities through NHS @home ensuring that patients from ethnic minority groups and those patients who have been disproportionally affected as a result of the pandemic are prioritised and that all work seeks to reduce the health inequalities gap.

There is scope for variation in the content and duration for each aspect of the of NHS @home programme and further details will be available from NHS England and NHS Improvement. The approach is likely to consist of use of identification and risk stratification tools, mobilisation of the wider primary care workforce (including personalised care roles in primary care – social prescribing link workers; care coordinators and health and wellbeing coaches) implementation of a personalised pathway (based on personalised care components, focus on self-management and maximising use of remote monitoring and digital tools.  The outcomes of interest are reduction in hospital admissions and face-to-face clinical contact where feasible/appropriate, reduced variation in care and demand on frontline clinicians, increased out-of-hospital care, increased patient knowledge, skills, and confidence to manage their own condition, increased quality of life, quality of care and experience and improved workforce experience.

Evaluation

Proposals to the HD&DR Programme are likely to be mixed-method studies led by a team or syndicate of teams with a track record in multi-site evaluations of complex interventions. The HS&DR Programme wants to fund an ambitious national evaluation with multiple work packages, similar to the large-scale NIHR assessment of the National Diabetes Prevention Programme currently underway. No particular study design is prescribed, but components of the evaluation are likely to include the following:

  • Service mapping of scope and activity of NHS @home programmes, including delivery mode, workforce, scope, and uptake
  • Baseline data collection and scoping of activity and outcome data (coverage and quality) for measurement and linkage
  • Observational and other qualitative research on service user and staff experience
  • Assessment of impact, using analytics from routine data, prospective cohort studies and other approaches
  • Cost and economic assessment of the programme
  • Focus on organisational issues and implementation of the programme’s different elements

The call is looking for well-designed national research studies, with strong theoretical grounding, to deliver robust national learning, strengthen the evidence base on use of NHS @home approach and provide actionable findings for the NHS. Use of appropriate controls or comparisons should be considered to increase robustness of evaluations. The focus should be on measuring the impact of the NHS @home approach, rather than research which is only descriptive.

Proposals will support decisions about the impact of the NHS @home roll out and implementation at scale to help adoption and adaption to various communities, commissioners, individuals and organisations across health and social care. The findings will provide evidence on the various components of the NHS @home approach and may also help to identify active and effective elements as well as assessing the impact of the complex intervention overall, providing decision-makers with indicators when commissioning, implementing, and embedding NHS @home.

The successful team(s) should expect to have regular contact with key stakeholders at NHSEI and build in appropriate plans to share regular interim outputs and a worked-up plan for sharing tailored findings for different audiences.

General Guidance

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 required to ensure 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 Systems. As this research may be conducted during the COVID-19 response and recovery stage, applicants should consider how the impact of COVID-19 response and recovery may affect their ability to conduct the 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 HS&DR Programme supports applied research with the aim of improving health and social care services across the nation and is open to any methodology which is appropriate to answer the proposed research question; this must be fully explained and justified. 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.