Closing date: 1pm on 15 March 2023
Scope
The Health and Social Care Delivery Research (HSDR) Programme wants to fund a high-quality research evaluation of a national programme of Complications from Excess Weight (CEW) clinics for children and young people. This research aims to develop the evidence base and learn from pilot clinics in order to generate understanding of the optimal models of care for complications relating to obesity in childhood. The research should contribute to a national CEW clinic framework supporting the roll out of the programme, and to inform commissioning of services by Integrated Care Systems by 2024/2025.
The HSDR Programme is interested in receiving applications for mixed-methods research studies, with strong theoretical grounding, to generate robust evidence on optimal service models, combinations of treatment interventions and conditions of success for this cohort of children and young people. The proposed evaluation will include both analysis of routine data sets and primary data collection and the successful research team will work closely with NHS England and NHS Improvement (NHSEI) regarding access to data and sharing interim outputs. Any development or testing of new treatments, or the efficacy of medication, is out of scope for this call.
Background
Obesity affects one in four children in the UK and can increase the likelihood of a child developing serious health issues such as Type 2 diabetes, liver conditions and early heart disease. Childhood obesity and excess weight are significant health issues for children and their families, with serious implications for a child’s physical and mental health which can continue into adulthood. Vulnerable children and young people have been disproportionately impacted by the COVID-19 pandemic, and childhood obesity rates have starkly increased . The NHS Long Term Plan contains ambitions to treat more children who have severe complications related to their obesity to prevent them needing more invasive treatment.
The NHS is commissioning clinics across the country to provide a treatment offer for children and young people living with complications related to severe obesity. Complications from Excess Weight (CEW) clinics take a holistic approach to treating conditions related to obesity in children and young people. Twenty-one clinics are currently operational and care is delivered by a multidisciplinary team, linked to a specialist children’s hospital. CEW clinics aim to: identify factors involved in the development of severe obesity through a holistic assessment, treat complications relating to severe obesity, and consider an individualised comprehensive plan that may include interventions such as family-based therapy, behavioural coaching, dietary strategies, and mental health support.
Evidence is needed on which service model and interventions are most likely to succeed for this cohort of children. Nationally, high level principles in the CEW Clinics Framework have set out what care delivery through the CEW clinics should entail. Further details of the core elements of the framework are available as a supporting document upon request from hsdrinfo@nihr.ac.uk. With clinics and regions having developed tailored models to suit their local population, this call for research provides an opportunity to understand the patient cohort at a national level and to evaluate a range of different service configurations and treatment interventions.
Areas of interest
The HSDR Programme wishes to fund high-quality, mixed-method evaluations, with strong patient and public involvement, which explore the impact of CEW clinics for children and young people on a range of patient, service and system outcomes. To provide national learning, studies are likely to be ambitious in scope with multiple workstreams, similar to HSDR studies such as the Programme of Research for Alcohol Care Teams: Impact, Value and Effectiveness, or the completed projects on Optimum models of hospice at home services for end-of-life care in England: a realist-informed mixed-methods evaluation and Early Evaluation of the Children and Young People’s Mental Health Trailblazer programme.
Study designs will need to account for the complexity of different service configurations and treatment interventions with variation in delivery across the pilot sites. Research teams will be able to analyse the data collected through the national CEW evaluation dashboard currently being developed, in addition to gathering qualitative data from research sites and other data to support monitoring the longer-term impact of CEW clinics for children and young people. The evaluation will provide an overview of the pilot programme as a whole as well as `deep dive’ analysis of sampled sites. The study will commence in December 2023, with the scoping phase completed by February 2024 and a full evaluation plan developed. The successful research team will work closely with policy colleagues and attend CEW Delivery Board meetings to share emerging findings. An interim report is expected by April 2025, with the final report to be available in summer/autumn 2026.
The nature of the services offered by clinics is personalised, and holistic plans are based on the needs of the individual child and family. Each child might have different complications in relation to obesity and related physical and mental health and social care needs. This poses challenges for evaluation given the range of possible interventions. The interest of the HSDR Programme is in evaluating the clinics as a new model of care. The effectiveness of individual treatments (including medications and therapeutic support) is out of scope. Instead, applicants are asked to consider the clinics and their services as complex interventions. Thoughtful evaluation design is needed to assess clinics offering different bundles of services and to extract learning about overall impact and conditions for success, likely gains and challenges, optimal models and ways of working. Revised MRC guidance on evaluating complex interventions will be helpful.
Although the HSDR Programme is not prescriptive about design, evaluations will include the following elements:
- Identification and testing (if necessary) appropriate measures and data sources to assess programme outcomes and impacts at different levels and timelines. These will include patient experience, engagement rates, range of health and wellbeing outcomes (including reduction of medical complications related to excess weight), as well as social measures and other impact such as school attendance/employment status.
- Understanding the demographic and clinical characteristics of children referred for treatment of comorbidities relating to their obesity and how this relates to the general population of children with obesity.
- Evaluating different service models. This will include dimensions such as spoke/hub/outreach, single vs split site, virtual vs face-to-face, relative location to associated sub-speciality colleagues.
- Mapping what care is being delivered and the range of services at each clinic (medical, dietary, behavioural, physical, psychological and social). This links to staffing, as set out below.
- Qualitative work with children and families to understand barriers and enablers to engage with services and maintain commitment over time. This would include perceptions of new models of care, strategies to improve access and uptake of services and following up those not engaging with services.
- Assessing workforce models including leadership, multidisciplinary team configuration and skill set/training of team members. Given the HSDR Programme’s interest in workforce, studies should pay attention to issues such as new ways of working, extending scope of practice or new roles, interprofessional and cross sector team working and communication.
- Understanding cross-organisational or integrated models of care across the patient pathways; CEW clinics as part of a networked model of care including the impact of availability of existing community weight management services on efficacy and demand at CEW clinics.
- Given the link between inequalities and prevalence of obesity, research should address inequalities in access, outcomes and experience of services, including factors such as (but not limited to) economic deprivation, learning disability, autism and special educational needs and disabilities, ethnic minority communities, and digital exclusion.
- Evaluating the cost-effectiveness of interventions or programmes of care, including modelling to predict and understand the relationship with long-term benefits for the NHS and local government in terms of reducing future health and social care needs across the life-course and wider societal benefits. This might include any adaptation of standard measures to project long-term gains from interventions in childhood through cost avoidance approaches.
Studies may be delivered by a team or coalition of teams with a track-record in national evaluations and likely to include expertise in areas such as health economics, large-scale data analysis and modelling, and qualitative research methods including measurement of patient experience and involving children and young people in research.
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 that 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 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 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 health and social care delivery processes, is suggested. It is useful to consider, in the research design, how outcomes could be scaled up to maximise impact and value for money across health 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 is available on the HSDR Programme webpage.
Research proposals should be co-produced with national organisations and professional bodies, with health and social care services professionals, and with service users. Links with health and social care planners and with professional bodies are required to ensure impact and scaling up of any research findings to benefit the wider health and social care systems.
The COVID-19 pandemic is having a significant impact across the health and social care systems. As this research study 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 and deliver the research study proposed.