Scope
The Health and Social Care Delivery Research (HSDR) Programme wants to fund ambitious, impactful research evaluations alongside the roll-out of the High Volume Low Complexity (HVLC) surgical hubs model. Implementation of this model is currently focused in England but there is scope to design studies using comparative data from across the UK as part of the proposed evaluation. Study designs will need to account for the complexity of HVLC model (the intervention) and its spread, with variation in the maturity and uptake of the HVLC model between and across regions.
The HSDR Programme is interested in receiving applications for high-quality research studies, with strong theoretical grounding, to generate rigorous and robust evidence that will develop understanding around clinically led, sustained change management in health services delivery and provide valuable and impactful national learning.
Research teams may be able to access national data on activity and outcomes by specialties and pathways, together with the latest service mapping of the HVLC surgical hubs, through Getting it Right First Time (GIRFT) and policy/service contacts. The successful research team will be able to discuss data access with NHS England and NHS Improvement (NHSEI) at a later date.
Background
Disruption to usual services, during the COVID-19 pandemic, led to over 387,000 people (at April 2021) waiting more than one year for routine operations and procedures, the highest number reached since records began in 2007 (BMJ, 2021). The Royal College of Surgeons of England have called for action with a twelve-point plan - a “new deal for surgery” to support the recovery of elective surgical services. The GIRFT programme is working with local health care systems to support post-COVID-19 elective recovery, with the aim of reducing the backlog of patients waiting for operations and procedures and to improve access to care and outcomes. Up to 60% of people on waiting lists are waiting for common procedures such as cataract removal, hernia repair or joint replacement operations.
As a key element of NHSEI elective recovery plan, and as part of GIRFT, the HVLC programme is developing standardised patient pathways across regions. This work is focusing, initially, on driving improvement in six, high-volume specialties – ophthalmology, general surgery, trauma and orthopaedics (including spinal surgery), gynaecology, ear, nose and throat and urology. Following initial work in London, integrated care systems will be working with partners to develop surgical hubs and patient pathways, pooling capacity and resources and agreeing system-wide operating theatre principles and efficiencies. In line with population needs, local systems are encouraged to identify their own priorities and use the GIRFT specialty ‘gateways’ to benchmark and review their performance against relevant metrics with a focus on clinical outcomes and equitable access to care.
Areas of interest
The HSDR Programme wishes to fund high-quality, mixed-method evaluations, with strong patient and public involvement, which will explore the impact of HVLC surgical hubs on a range of patient, service and system outcomes. This will include trade-offs between different system elements and any unintended impact on patient safety and the wider system. To provide national learning from a dynamic, complex, transformation programme, studies are likely to be ambitious in scope with multiple workstreams, similar to HSDR programmes of work on the National Diabetes Prevention programme or the national evaluation of the roll out of social prescribing link workers in primary care, currently underway, or the completed evaluation of the reconfigurations of acute stroke services across England.
Studies may be delivered by a team or coalition of teams with a track-record in national, complex evaluations and likely include expertise in areas such as implementation science, health economics, organisational change, large-scale data analysis and modelling and qualitative research methods including measurement of patient and staff experience.
It is expected that successful projects should identify and feedback insights on a regular basis, during the course of the study. Research applicants may want to consider the use of tracer specialties, specific patient pathways or localities to allow for comparative evaluation.
Although not prescriptive about design, successful projects are likely to include the following elements:
- Analysis of care processes, outcomes and activity to ascertain the impact and effectiveness of HVLC hubs for geographical areas with different contexts, profiles and demographics. This is likely to require quasi-experimental approaches to take account of the spread of this innovation over time and across England. Careful thought will be needed to identify appropriate comparators.
- Focus on health inequalities, including assessment of equity of access, uptake, experiences and outcomes across different populations. Attention should be paid to issues of equality, diversity and inclusion in all elements of the study, such as sampling, analysis, and support strategies and approaches for reaching under-served communities.
- Focus on workforce, including impact on ways of working and deployment, staff shortages and capacity building, professional boundary shifting and skill substitution and implications for staff training, skills development and retention.
- Implementation of HVLC hubs – how have changes been enacted and experienced? What are the barriers and facilitators to implementation? This will include exploring interdependency within the system and the capture of both positive and negative impacts of the HVLC model on other areas such as primary care, emergency care, social care as well as other parts of acute services.
- Exploration of service transformation and culture change - what lessons are there for the wider implementation of the HVLC surgical hubs model across the NHS as a whole? What are the key characteristics of successful implementation and sustainability of the model? Are the lessons of this service transformation transferable to other change programmes? What elements of organisational culture and leadership have supported large-scale change in particular contexts?
- Costs of HVLC hubs in relation to impact and effectiveness. While a full cost-effectiveness analysis may not be possible, economic input is needed to understand any changes in resource use and inputs, and the potential effects on system performance and efficiencies.
- The impact of the HVLC model on patients’ and carers’ experience (including views on travel/transport, nature/suitability and accessibility of premises). How any changes have affected the patient pathway, including continuity of care before and after surgery and on follow-up? Work is needed to understand patient satisfaction and experience and how feedback is captured and used by provider organisations.
Equality, diversity and inclusion
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.
General Guidance
The HSDR 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 the 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 on systems that improve the quality, accessibility 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 can be found on the HSDR Programme webpage.
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 pandemic 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 period, applicants should consider how the impact of COVID-19 response and recovery may affect their ability to conduct the research.