The Health and Social Care Delivery Research (HSDR) Programme wishes to fund up to 3 national evaluation teams, ready and prepared to conduct, at short notice, substantive, in-depth assessments of large-scale service changes. Each team will have a contract of up to £3m over 5 years.
Why do we need these teams?
Large-scale and often complex changes have been rapidly introduced to health and social care in recent years. Some of these changes involve substantial shifts in how services are organised and delivered and, inevitably, may have intended and unintended consequences. Some of these changes may also be introduced at pace, often in successive waves. Some may be supported for a limited time by central funds before local commissioners are asked to make decisions about continued longer-term adoption and investment.
The HSDR Programme has funded a number of rapid evaluation teams. These have evaluated service innovations with rapid, early evaluations, usually over a 6 to 12 month period, ranging from pulse oximetry at home to womens’ health hubs. There has, however, been limited capacity to provide more substantial full-scale longer-term impact assessments.
There is a need for high-quality research team(s), with experience and a track-record in mixed-method evaluation, to be ready and prepared to conduct, at short notice, substantive, in-depth and timely 'alongside evaluations' of large-scale service changes. These might be 2 to 3 year evaluations, similar to studies conducted through our commissioned and researcher-led calls, but with the added feature of being able to start quickly as the health and social care changes are being introduced, and deliver useful interim findings to the service at regular intervals during the course of the project.
In the past, HSDR has successfully funded high-quality 'alongside evaluations' of important national service transformations of this kind. Examples include optimised alcohol care teams, new surgical hubs for high volume low complexity elective work, and midwifery continuity of care models. Appointing experienced research team(s) ready to start swiftly will maximise impact for commissioners and practitioners by increasing the timeliness of such evaluations, without compromising on scientific rigour.
What is the scope of activity?
Substantive evaluation of this kind differs from rapid evaluation, in the scale of activity anticipated and the extended focus on medium-to-longer-term impact of service change. Many of the service changes to be evaluated are complex interventions that require more detailed, mixed-methods studies to evaluate effects on the wider health and care systems, as well as on the immediate population or service(s). Studies would use theoretically informed approaches to evaluation, drawing on implementation science and relevant organisational research. The HSDR Programme has a central focus on the organisation and delivery of health and social care services encompassing workforce, and prioritises equity of access and experience in all aspects of its work.
A typical substantive evaluation of 2 to 3 years for these new teams might include:
- Service mapping and development of taxonomy of models of care
- Embedded formative evaluation with early learning from demonstrator or pilot sites
- Understanding or testing data accuracy (completeness, validity and reliability) and linkage for any proposed quantitative evaluation
- Qualitative research, including observation case study sites and interviews, and/or focus groups with staff and service users
- Evaluation of models of care, including impact on staff and ways of working, including questions around workforce, such as role boundaries, role substitution and skill mix, staff satisfaction and experience
- Assessing wider organisation and systems-level impact including spill-over effects and changes to related services across settings
- Experience of patients, service users and informal carers in changes to pathways or access to services and care
- Impact assessment of services using routine quantitative data and data linkage over time
- Appropriate economic evaluation of service changes, which may include modelling work to assess longer-term benefits or harms
- Impact on equity in access and outcomes of services for high-risk or defined groups of interest
- Interim and final synthesis of findings into appropriate outputs for key stakeholders
How will topics be identified?
Each team would have a rolling programme of substantive studies. At any time, a team might be engaged in 2 substantive 3 year evaluations at different stages of progress.
The focus of evaluations will be determined by the HSDR Programme, as part of its priority-setting processes, working closely with stakeholders such as NHS England, Integrated Care Boards, commissioners of social care services, policy leads in devolved nations, professional groups in health and social care, and charities. The areas will likely include changes to address service pressures and priorities, from resilience and recovery to making best use of staff. At a very early stage, evaluation teams will typically be expected to engage with policy and service leads to negotiate the scope of the evaluation.
The work programme of each team will be identified by HSDR to complement existing activity of relevant parts of NIHR, including Policy Research Units, which have recently been recommissioned. The HSDR national evaluation teams will be expected to engage with relevant Policy Research Units (depending on topic areas) and similar facilities in devolved nations to ensure complementarity of work programmes and align findings to build a robust evidence around the evaluation of service innovations.
How will teams be selected?
There will be a 2 stage process to identify the evaluation teams. The first stage will be an expression of interest. Shortlisted teams will then be given 8 weeks to develop full proposals, with worked examples of past projects, details of team and approach to respond to challenges of complex national evaluations. Teams will be invited to an in-person interview in London.
Successful teams will have a track record in:
- Delivering high quality, national scale complex evaluations of large-scale service changes in health and social care
- Demonstrating a range of qualitative and quantitative methods
- Developing and nurturing high quality staff, with capacity to draw on wider range of research skills as needed (for example, operational research or data linkage) and support from the host organisation
- Accessing networks and contacts at a national level to draw on specialist content experts in a broad range of health and social care topics
- Engaging effectively with a range of stakeholders, including policy and service leads at local and national level, with experience of working together in scoping research approach and questions
- Commitment to equity issues, from data collection to engaging with seldom heard voices
Teams need to show experience in sharing findings in ways to generate impact, from high-profile academic publications to imaginative service and public-facing outputs using a range of media and platforms. Ability and commitment to engage target audiences and mobilise research findings will be an important hallmark of success.