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Compound pressures supporting information

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Published: 21 February 2023

Version: 1.1 November 2023

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Specific areas of interest for research

This NIHR themed call seeks research to respond to 5 major research questions facing public health, the NHS and social care. Within each research question, examples of areas of interest have been identified for primary research or evidence synthesis. This list is not exhaustive, and applicants are encouraged to respond creatively to the research questions posed. Proposals which span research questions and seek to solve problems at a systems level (either local, regional or national) are particularly welcomed.

How can the health and care system most effectively work together to plan for and respond to compound pressures?

Examples of areas of interest which have been identified for primary research or evidence synthesis include:

  • understanding the role that all parts of the health system, from community and primary care through to hospital-based and social care, play in delivering better outcomes for people
  • providing solutions for how the system can work effectively together to plan for and respond to compound pressures, for example the role of Integrated Care Boards and Hospital resilience strategies such as:
    • the impact of ring-fencing a proportion of beds for elective surgery
    • the impact of freeing up diagnostic services for emergency care

How can the health of vulnerable people be protected, and avoidable hospital admissions reduced?

Protecting the health of vulnerable people

Examples of areas of interest which have been identified for primary research or evidence synthesis include:

  • understanding the residual impact of COVID and continued endemic pressures
  • interventions focusing on preventing health conditions which drive demand (e.g. musculoskeletal, mental health, CVD, respiratory illness) for example through:
    • targeted vaccination or different vaccine delivery methods
    • rapid smoking cessation programmes
    • improved housing stock, and warm /cool homes
    • community spaces.
  • understanding who is most at risk of poor health or hospitalisation in winter, in extreme heat and weather, and why
  • interventions to protect the health of vulnerable people such as:
    • population level falls preventions (e.g. slip + trip free public spaces, lighting, targeted physical activity, food delivery services)
    • emergency housing to protect vulnerable populations from extreme weather events
    • ‘step up’ services
    • the role of community pharmacies
  • interventions focusing on geographical or socio-demographic areas of high demand and reducing inequalities in health outcomes in these groups

Preventing avoidable admissions

Examples of areas of interest which have been identified for primary research or evidence synthesis include:

  • interventions to reduce emergency admissions in vulnerable populations, for example:
    • the role of high-quality social care
    • early intervention when frail individuals start to be unwell
    • rapid access to enhanced smoking cessation on reduction in cardiac and respiratory admissions
    • interventions with high intensity users of accident and emergency services including consideration of disadvantaged and marginalised groups
  • effectiveness of service reforms on preventing avoidable admissions, such as:
    • Ambulatory Emergency Care and point-of-care testing by ambulance services
    • Same Day Emergency Care
    • single point of access services
    • medical/specialist in-reach services in care homes

How can illnesses which cause excess burden in winter, during extreme heat or infections with pandemic potential be more effectively diagnosed and treated?

Examples of areas of interest which have been identified for primary research or evidence synthesis include:

  • developing and evaluating diagnostics suitable for point of care use for rapid deployment (eg mass localised testing such as supermarket car parks, or specialist centres; rapid genetic sequencing of pathogens to allow bedside identification and targeted antimicrobial treatments)
  • developing and evaluating more effective treatments for illness that cause burden in winter (eg influenza), or during extreme heat and weather, and infections with pandemic potential
  • impact of interventions which reduce hospital stay such as rapid access to smoking cessation on reduction in post-operative complications and extended stays

How can routine services best be structured and supported to enable them to continue during times of increased pressure, and to recover quickly afterwards?

  • modelling to predict, understand and manage demand on health and care services
  • understanding the pressures on elective care to develop targeted interventions
  • impact of interventions to enable routine services and elective surgery to recover and reduce waiting lists such as:
    • community diagnostic centres
    • online booking systems
    • system control centres
    • new minimally invasive surgical procedures
    • AI algorithms to speed up a range of services (eg radiology screening and stroke management)
  • the effectiveness of adopting a health inequalities approach to routine services such as in the management of elective waiting lists
  • interventions to support the wellbeing and effectiveness of the health and care workforce including promoting mental health and vaccination rates

What works to reduce unnecessary hospital stay, promote smart discharge and reduce staff burden?

This theme draws on the evidence gaps identified through the recently commissioned NIHR mapping review of studies/initiatives relating to discharge planning and integrated care used in the UK in response to winter pressures. This review found that Discharge to Assess and Hospital at Home interventions were heavily used and well-supported by the evidence base, but other interventions, while also heavily used, were based on limited evidence. 

Examples of areas of interest which have been identified for primary research or evidence synthesis include:

  • understanding who is most at risk of delayed discharge in winter, and why including mapping patient flow between hospital and social care
  • interventions to improve appropriate discharge for example:
    • the role of social workers in multi-disciplinary teams in the management of discharges
    • integrated systems spanning acute and home-based services
    • multidisciplinary care provision
  • evaluation of smart and facilitated discharge models, Home First, step down beds and Integrated Care Discharge Huddles) focused on common shared mechanisms
  • impact of providing alternative care settings to hospitals such as:
    • Frail Elderly Short Stay
    • step down care
    • emergency housing solutions
  • providing care at home including remote social services, and virtual wards
  • impact of increasing community capacity through voluntary, community and social enterprise initiatives
  • the importance of patient preference and behaviours in supporting appropriate discharge, and ensuring treatment adherence post-discharge

Cross-cutting themes

For each research question, we encourage applications which consider:

  • the impact on disadvantaged and marginalised groups and how to reduce health inequalities in access to, experience of and outcomes from health and care services
  • implications for carers and carer-centred outcomes
  • patient, carer and provider needs and experiences
  • understanding workforce roles and skills
  • how to promote culture and behaviour change within organisations
  • the cost-effectiveness of interventions and other economic evaluations, including health and care sector costs
  • how to ensure uptake of findings into policy and practice including how to scale interventions

Study designs

We welcome a wide range a study designs to answer these questions, including:

  • novel and efficient study designs
  • making use of existing data sets
  • natural experiments
  • whole systems approaches to understand the impact that interventions have on changing the whole system and exploring unintended consequences

Priority cross-cutting methodologies

To deliver research and innovation which enable a step change in policy and practice, we encourage applications from researchers in the following disciplines, with particular emphasis on inter-disciplinary teams.

Systems thinking

Reducing compound pressures on the NHS and social care is a complex problem which requires a 'systems' approach. Successful transformation requires consistent consideration of every element of the system, the way each element interacts, understanding where the core problems in the systems lie, which are amenable to intervention, and the implications of these interactions for the system as a whole.

Data science

Analysis of large-scale data from across the health and care system is critical for a range of research priorities, including:

  • identifying risk factors
  • improving diagnosis
  • predicting outcomes
  • increasing the effectiveness of treatments
  • understanding and mitigating pressures on the health and care system

Economics of health

Economic expertise is required to understand and improve the cost effectiveness of innovations and services to ensure that they deliver economic and health benefits.

Behavioural science

Social, behavioural and anthropological expertise are needed to ensure that innovations and services are designed to be acceptable, feasible and scalable, as well as effective.

Implementation science and use of real-world evidence

Understanding how to make interventions work effectively in practice, at scale and in different contexts is critical to converting what we know works (for example from randomised controlled trials) into changes in policy and practice. This kind of ‘adoption’ research evidence is frequently overlooked and its absence is a key contributor to the slow pace of adoption of innovation in the NHS.

Evidence synthesis

Timely, policy-facing synthesis of bodies of evidence are needed to inform policy making, including realist reviews synthesising effects of interventions within complex systems.

Participating NIHR programmes

Research proposals must be with the remit of one of more of the participating programmes outlined in this section and must focus on addressing one of the following 5 major research questions:

  1. How can the health and care system most effectively work together to plan for and respond to compound pressures?
  2. How can the health of vulnerable people be protected, and avoidable hospital admissions reduced? Specifically protecting the health of vulnerable people and preventing avoidable admissions
  3. How can illnesses which cause excess burden in winter, during extreme heat or infections with pandemic potential be more effectively diagnosed and treated?
  4. How can routine services best be structured and supported to enable them to continue during times of increased pressure, and to recover quickly afterwards?
  5. What works to reduce unnecessary hospital stay, promote smart discharge and reduce staff burden?

MRC – NIHR Efficacy and Mechanism Evaluation (EME)

The EME Programme welcomes proposals to evaluate novel or repurposed technologies or interventions that have the potential to reduce the resource need for treatment in an affected pathway, compared to current alternatives, whilst maintaining or improving treatment efficacy. For example, such technologies may:

•    require less staff time
•    require less intensive/invasive treatment
•    require or result in shorter duration of stay in hospital
•    be deliverable in alternate settings which would be able to accommodate them

The focus of the research must be the efficacy of the treatment and/or its mechanism of action. Studies funded by EME are not expected to produce definitive evidence on the effectiveness of interventions, however, applicants should demonstrate that the technology or intervention has the potential to impact compound pressures in the longer term, if proven to be efficacious.

Health and Social Care Delivery Research (HSDR)

The HSDR Programme is interested in research which improves the quality, accessibility and organisation of health and social care services. For example research in relation to compound pressures could explore:

  • different models of care
  • care pathways
  • service delivery
  • care systems and settings

Alternatively, the research may assess and evaluate the impact on the health and social care workforce, service users and their carers or families. A wide range of methods and study designs are welcomed, including mixed-methods studies, in the HSDR Programme.

Health Technology Assessment (HTA)

The HTA Programme funds research about the clinical and cost-effectiveness, and broader impact of healthcare treatments and tests, for those who plan, provide or receive care from NHS, and social care services. HTA has a remit to carry out comparative research to better understand the impact on people of receiving health and social care interventions. HTA research is undertaken where some evidence already exists to show that a technology can be effective, and this needs to be compared to the current standard intervention to see which works best.

Invention for Innovation (i4i)

The i4i Programme supports the preclinical and clinical development of medical technologies in areas of existing or emerging patient need. The Invention for Innovation programme is a translational research funding scheme aimed at de-risking early-to-late stage medical devices, in vitro diagnostics and high-impact patient-focused digital health technologies for ultimate NHS use. The programme funds projects that have demonstrated proof-of-concept and have a clear pathway towards adoption and commercialisation - further information is available.

Programme Grants for Applied Research (PGfAR) and Programme Development Grants (PDG)

The PGfAR scheme is interested in programmes of research which involve a number of inter-related and linked components, using a range of methodological approaches, to answer important questions relevant to research to support the reduction of compound pressures on the NHS and social care. Applications employing novel methodological approaches to demonstrate benefits at an individual or population level are encouraged. Examples include:

  • development and testing of interventions (including links with industry)
  • using observational data to demonstrate benefit
  • public health interventions; social care perspectives
  • use of existing data from previous research, or routinely collected health care data

Applications which clearly demonstrate multidisciplinary approaches and are conducted in geographical locations of high health care need will be welcomed. Research may be carried out in community, primary or secondary care settings.

Public Health Research (PHR)

The PHR Programme is interested in funding evaluations of non-NHS interventions and prefers looking at those that act at a population, rather than individual, level. The Programme is particularly interested in the role of local government and the voluntary sector in the context of compound pressures. Those populations that are most vulnerable to compound pressures are of interest and should be defined carefully, with involvement of those communities in the development and undertaking of any research encouraged.

Research for Patient Benefit (RfPB)

The RfPB Programme supports research that is concerned with the day-to-day practice of health service and social care staff. Research proposals should have a clear trajectory towards benefiting the health or wellbeing of patients and users of the NHS and social care services. Applications to the RfPB Programme should seek to solve pressures which arise from daily practice in NHS and social care services, and must demonstrate a trajectory to patient, service user, and/or carer benefit.

The programme supports applications which are regionally derived and are concerned with studying the provision and use of NHS and social care services, including:

  • access to or some aspects of delivery of services
  • evaluating the effectiveness and cost effectiveness of new innovations and interventions
  • developing and refining new interventions

Research methods may involve primary research or evidence synthesis, including systematic reviews, modelling studies or the analysis of existing datasets. The programme would not fund service developments, unless they have wider generalisability or audits or surveys, although these elements may be part of an integrated research study.

The call offers researchers considerable flexibility to focus on any subject area, topics and research methodologies.

Research Programme for Social Care (RPSC)

RPSC invites research applications that directly address the challenges outlined in the NIHR Compound Pressure Themed Call in adult and children’s social care services across the UK. Research is needed to identify and assess how all parts of the social care system (including community and voluntary service initiatives, model of integrated planning of social care and other services such as health, housing, workforce) can work effectively to reduce the impact of compound pressures.

RPSC applications should arise from the challenges and the unmet needs for people using social care services and how pressures on social care services can be exacerbated due to Compound Pressure and what solutions, short or long term, can be implemented to reduce such challenges. Researchers should choose methodology appropriate to the research question and objective related to the Themed Call. 

The programme offers researchers considerable flexibility to focus on topic area, community, and services that require addressing; however, the following are examples of the focus areas that DHSC and NHS policy makers are interested in:

  • developing, evaluating and understanding how to implement effective community based and early-stage interventions - this includes an understanding of the workforce and skills needed; ‘step up’ services; models of social care interventions in communities
  • interventions to enable routine social care services to continue during times of increased pressure (such as social care system pressure, resilience and strategic interventions)
  • reducing hospital stay, promoting smart discharge, reducing staff burden, in particular applications on the role of social workers in multi-disciplinary teams in the management of hospital discharges; compound pressures, and the implications on carers and carer-centred outcomes

NIHR Academy

The NIHR Academy is responsible for the development and coordination of NIHR academic training, career development and research capacity development. The purpose of the NIHR Academy is to develop a highly-skilled academic research workforce capable of advancing the best research, which improves health and benefits society and the economy. Further information on the Academy programme is available, along with information on the ICA (Fellowship) Programme Round 3.