Scope
The NIHR Health and Social Care Delivery Research (HSDR) Programme is interested in receiving proposals for well-designed research studies to strengthen the evidence base on optimal models for reablement services in the UK. The Programme welcomes proposals for cross-UK studies. The main aim is to generate evidence to provide an overview and evaluation of models of reablement services through large-scale and multisite research studies with investigation of the service and, intervention and evaluation of individual characteristics of these on reablement outcomes. For this Commissioned funding call, the focus is on general reablement services rather than condition-specific services, such as, stroke – which have specialist pathways, teams and evidence base. The Programme is open to any methodological approaches that are appropriate and fully justified to answer the proposed research question.
Areas of interest
The NIHR HSDR Programme would like to fund high-quality, mixed-method research studies which explore the impact of different models of reablement services on a range of patient/families, service and system outcomes, drawing in learning from across the UK. These studies will build on previous evidence and address important research gaps identified by NICE and others.
Research proposals should have strong staff, patient and family involvement to ensure that the proposed research asks the right questions and is conducted in a way that will provide actionable findings to improve health and social care services. The research funded will be intended to improve: the effectiveness, humanity and equity of services; the outcomes for people who use services and their carers/supporters; health and social care professionals’ practice; and the provision of evidence for commissioners and decision makers. The Programme is interested in looking at impact on individuals as well as organisations and different parts of the wider health and social care system.
The following areas are of particular interest, though other research questions may be proposed with justification:
- Improving organisation and delivery of reablement services, including care pathways and investigation of emerging new approaches; investigation of service, intervention and individual/family member characteristics on reablement outcomes; crisis response services, discharge to assess units or ‘step-down’ care.
- Models and economic evaluation of reablement services appropriate for particular groups (for example, people living with dementia, complex needs or multiple conditions) including more holistic/comprehensive approaches to reablement; understanding what reablement means for different groups where expected outcomes may vary.
- Comparison of organisational models and diversity of reablement provision, including inhouse and outsourced services, voluntary, social enterprise and other sources of care.
- Effectiveness and cost effectiveness of repeated periods of reablement; duration, frequency and longer-term impacts.
- Testing and validating outcome measures for reablement including appropriate measures of social connectivity and of what matters most to patients and families, including different groups; and measuring outcome trajectories following discharge.
- Workforce approaches to develop new staff roles and enable professional development including models of induction, training and supervision; optimal skill mix and models of multidisciplinary teams delivering reablement services and changing responsibilities or scope of practice for different therapists.
- Patient and family/carer experience including acceptability and accessibility of reablement services, with a focus on different patient groups and on health inequalities.
- Use of technology and innovation in reablement services.
- Positive deviance approaches to learn from exemplars of cross-sector working (primary care, acute, community, social care), for example, enhanced social work and health integration, or whole system approaches.
Proposals should include a clear pathway to impact with links into health and social care service delivery. It is useful to consider in the study design how outcomes could be scaled up to maximise impact and value for money across the system – the focus is on applied research with tangible impacts that improve the quality and organisation of health and social care services.
Identified research need
Research to understand the effectiveness and cost effectiveness of models of reablement services was identified by NICE guidance (NG74) and prioritised by external stakeholders as an important issue. While reablement has been implemented in many high-income countries, with aims to promote independence and reduce public health, social care and personal care costs, by minimising premature admissions to acute and longer-term care settings, the evidence base for reablement services is limited. There is a lack of research on patient-focused outcome measures and on what reablement services can do to support maintenance of outcomes and prevent decline.
There are some challenges in drawing comparisons across the existing research evidence as different service models are adopted in different countries or localities, indicating that wider reviews may not be comparing like with like. However, the flexibility of a reablement approach means that differences can be accommodated in varying contexts, environments and populations, while the key features and primary aims remain intact (Aspinal et al, 2016). Overall, in terms of the evidence base, there is ambiguity about whether reablement services can affect individual outcomes, other than daily activities, or reduce the longer-term need for health and social care services (Aspinal et al, 2016). A critical review of reablement (Doh et al, 2019) suggests that the processes of reablement, with their degree of context dependence, are bound to result in variability and that this should be viewed, in turn, as human inevitability not lack of consistency. This review also recommends that, as part of a reablement approach, practitioners and researchers should include a focus on social connectivity as well as physical functionality.
A Cochrane review found limited and low quality evidence assessing the effects of reablement services for maintaining functional independence of older adults, indicating considerable uncertainty around the impact of these services in terms of quality of life, living arrangements, admissions to hospital or death rates. Most research also focuses on short time-frames, with limited evidence around the longer-term impact of reablement. NICE guidance (NG74) highlights that research is needed to evaluate what works in terms of planning and delivering reablement services for different populations and further understanding is needed on the experiences of minority ethnic groups. NICE (NG74) also recommends that evidence is needed on different intensities and durations of home-based reablement care for people with a range of care needs, in order to establish the effectiveness and cost effectiveness of different approaches.
The HSDR Programme funded a mixed-methods study, in 2019, to evaluate the impact of reablement services on outcomes, costs and cost-effectiveness, user and practitioner experiences; and to investigate specialist reablement services/practices for people with dementia. The evidence for comparative and cost-effectiveness of service models was inconclusive and that, given the problems of availability and quality of data at that time, new research would add value and build on the preliminary findings and methodological insights. This study, however, noted that organisation and delivery of reablement services in England varied greatly with substantive differences in scope of activity and staffing structures. This study recommended further research to inform commissioning, strategic and practice decision-making, requiring large-scale, multisite, mixed-methods, outcomes and economic evaluation of reablement. In addition, it highlighted current practice in reablement for people with dementia and recommended that further research was required to support evidence-informed guidance on this area.
To encourage cross-sector working to reduce the time people spend in hospital when they no longer need acute care, guidance on ‘discharge to assess’ was published in 2016, and this approach had been adopted in some areas. However, the response to the COVID-19 pandemic intensified the need to discharge people from acute services and the discharge to assess policy was nationally mandated and funded from March 2020, driving new ways of working. Localities are now considering whether to continue these arrangements, going forwards, giving rise to uncertainties and the need for research to support best practice.
Equality, diversity and inclusion
The NIHR is committed to actively and openly supporting and promoting equality, diversity and inclusion (EDI). All NIHR research proposals need to demonstrate that they have met the requirements of the Equality Act (2010) by embedding EDI throughout their research study, ensuring that 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; and being pregnant or on maternity leave. Applicants are expected to pay attention to populations that have been underserved, to conduct research in locations where the need is greatest, and to promote the inclusion of diverse participants.
General guidance
The HSDR Programme supports applied research with the aim of improving both health and social care services across the nation and is open to any appropriate methodological approaches to answer the proposed research question(s); the approach must be fully explained and justified. In order to enhance the success of a research proposal, a clear theory of change and pathway to impact, with links into the NHS and social care services delivery, is suggested. It is useful to consider in the research study design how outcomes could be scaled up to maximise impact and value for money across the NHS and social care services – the focus is on applied research with tangible impacts that improve the quality and organisation of health and social care services. This includes stakeholder engagement and the development of processes, tools and guidelines to strengthen workforce capacity. Further general information is available on the HSDR Programme webpage.
Research proposals should be co-produced with national organisations, professional bodies, health and social care service professionals, and service users. Links with health and social care planners and professional bodies are required to ensure impact and scaling up of research findings to benefit the wider health and social care system.
The COVID-19 pandemic 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 period, applicants should consider how the impact of the COVID-19 response and recovery may affect the deliverability of their research.