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NIHR Challenge: Maternity Inequalities Specification Document

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Published: 13 March 2024

Version: 1.0 March 2024

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Summary

The National Institute for Health and Care Research (NIHR) is keen to generate high quality evidence to drive actions to reduce maternity inequalities and improve outcomes for women and children across the UK.

Through the first ‘NIHR Challenge’, the NIHR is looking to commission a research consortium bringing together leading institutions, in collaboration with other partners, from across the UK with expertise in research, capacity building and engagement with diverse populations. The consortium will develop and implement a research and capacity building programme to deliver a step change in the health of both women and their babies and support those who plan, commission, manage, deliver and use services across the health, public health and social care sector.

This call is part of a coordinated response by the NIHR to the UK Government's top priorities to be tackled under the Women’s Health strategy in 2024.

Research is needed to identify, assess and evaluate how all interventions across all parts of the health and care system (including initiatives in community and voluntary services, social care, public health, primary and secondary care, discovery science and AI) can work effectively to reduce the impact of maternity inequalities and lead to better outcomes.

It is expected that the research consortium funded through this call will ultimately result in a unified approach to increase the evidence base and develop the next generation of researchers to understand what are the most effective and cost effective interventions to reduce maternity inequalities including facilitating the pathway to implementation and associated knowledge mobilisation activities.

The consortium will act as a centre of gravity and draw in other relevant stakeholders and utilise existing NIHR investments across capacity building, infrastructure and programmes to generate a step change in maternity inequalities.

Background

Since 2009-11, maternal mortality in the UK has increased by 26%. The Women’s Health Strategy for England (2022) sets out improvements in the way in which the health and care system listens to women’s voices, and aims to boost health outcomes for women and girls across the life course.

The most recent MBRRACE-UK (Maternal, Newborn and Infant Clinical Outcome Review Programme) confidential enquiries into maternal deaths in the UK between 2019-2021, reported that black women were almost three times more likely and Asian women were twice as likely to die during pregnancy or up to six weeks after pregnancy compared to white women.

Women from more deprived areas were two times more likely to die than those from less deprived areas and the maternal mortality rate in this group of women continues to increase.

In addition to disparities in maternal health, poor pregnancy outcomes such as preterm birth, fetal growth restriction and stillbirth, disproportionately affect Black and Asian women from the most socio-economically deprived backgrounds (Adverse Pregnancy Outcomes Attributable to Socioeconomic and Ethnic Inequalities in England, The Lancet).

Hence, reducing maternity inequalities is a key aim of NHS England’s CORE20PLUS5 approach that informs actions to reduce health care inequalities. The NHS has also committed to “Improving equity and equality in maternity and neonatal care”.

Aims and Scope

The aim of the NIHR Challenge is to increase the evidence base to drive actions to reduce maternity inequalities and lead to better outcomes for women and their babies.

The purpose of the NIHR Challenge is to:

  • Bring together a diverse consortium membership, funding research and capacity building, to increase the evidence base to address today’s maternity inequalities and develop the next generation of researchers. Capacity building in this area in the consortium will be as important as the research.
  • Determine the priority theme topics within maternity inequalities, drawing upon ongoing and recent activity in this area, and develop and conduct high-quality innovative research to understand and address them
  • Undertake large scale integrated transformative projects spanning the entire research innovation pathway, with associated KPIs, to drive measurable improvements against each research theme
  • Provide a focus for maternity inequalities within the NIHR, as well as provide strategic leadership for the development of maternity inequalities research more generally
  • Develop methodological rigour and broaden the methodological repertoire, including bringing into maternity inequalities research a number of disciplinary perspectives currently under represented.
  • Ensure research is undertaken where the need is and will have the greatest impact where the need is greatest
  • Provide a programme of capacity building awards and opportunities for multidisciplinary training and career development that contribute to ongoing efforts to build research capacity and improve research awareness. Capacity building and training opportunities should be built into the consortium such that the training needs of all staff in the consortium are considered and supported.
  • Disseminate findings and support other knowledge transfer activities.

In its nature, the NIHR Challenge will:

  • Comprise leading academic centres of maternity inequalities research and other related relevant disciplines, working in collaboration with other relevant organisations, across the UK
  • Draw in expertise outside of the consortium membership from a range of collaborators which could include knowledge mobilisation, implementation, industry, practice, community, local authority, charity, and third sector partners spanning a wide geography
  • Build a closer relationship between maternity inequalities researchers and practitioners
  • Inform the future development of practice and ensure the findings are implementable in the current delivery system.
  • Attract, develop and support a cohort of maternity inequalities researchers from a broad range of under-represented disciplines and backgrounds in research
  • Promote and advance Equality, Diversity and Inclusivity in research subjects and in the research community itself.
  • Provide evidence to inform decision-making and best practice
  • Complement existing NIHR programmes and projects and actively seek collaboration with existing NIHR Infrastructure and other NIHR investments
  • Be directed by co-leads working with a consortium Executive Group (formed from successful consortium organisation members) and be responsible for the day-to-day running of the NIHR Challenge

Eligibility

To achieve Membership of the consortium, organisations will need to have a track-record of world-leading research within an area relevant to tackling maternity inequalities as well as a strong track record of developing research capacity. Organisations based in the UK and conducting relevant research with an expected benefit for the population of the UK will be accepted for consideration. Applications must be led by a university. While organisations are eligible to apply as a single organisation they are strongly encouraged to apply as a small collaboration with other organisations (approximately 2-4 members in total) which could include a mixture of: less established organisations, industry, practice, community, local authority, charity, and third sector, especially involving organisations where the need is greatest and where populations have been historically under-served.

We expect collaborative applications led by an organisation to fairly and proportionally involve their partners in the application and, if selected for the consortium, in the activity undertaken by the consortium.

Only one bid is allowed from each organisation whether as lead or collaborator.

Funding

Over five years, funding of up to £50m will be available to support the consortium. This will be split across research and capacity building, however the specific split will be agreed as part of the stage 2 process. In addition, the consortium will be expected to use its funding to involve organisations external to the consortium, where appropriate.

Funding for research projects will be up to 80% fEC and will be negotiated via the stage 2 process. A portion of the overall funding will be allocated to the successful consortium for the administration of the NIHR Challenge.

The indicative budget over five years (to be confirmed as part of stage 2):

  • 24/25: £5m
  • 25/26: £10
  • 26/27: £10m
  • 27/28: £10m
  • 28/29: £10m
  • 29/30: £5m

Continuation of funding over the five-year contract period will depend upon satisfactory performance, as determined by the DHSC.

Please note that non-research costs such as estates and capital investment are out of scope for this award.

The organisations selected to join the consortium will be allowed to badge themselves as members of the NIHR Challenge on maternity inequalities.

Selection process

The Membership of the NIHR Challenge consortium will be selected via an open competition.

The funding call will be a two stage process where stage 1 selects the individual organisations/collaborations to join the consortium. Only one bid is allowed from each organisation whether as lead or collaborator.The successful organisations/collaborations will then come together at stage 2 and develop the detailed work plan of transformative research and capacity building activity over the five year period as the NIHR Challenge consortium. Between stage 1 and 2 a process to select the co-leads of the consortium will occur.

Stage 1

Application forms will be submitted by multi-disciplinary organisations/collaborations in both the research team and capacity building and will be assessed by an independent expert selection committee, which will provide recommendations as to which applicants should go forward as members of the consortium. Members will be confirmed by the DHSC.

The application form will ask organisations/collaborations to:

  • Provide an overview of their existing research activity relevant to tackling maternity inequalities.
  • Include details on the research team and evidence that they are at the forefront of their field and how they will include and develop emerging research leaders.
  • Describe an innovative research strategy explaining how the organisations/collaborations will support the NIHR Challenge consortium and help meet the overall aims of the NIHR Challenge consortium.
  • Detail their approach to capacity building and support for attracting, developing and supporting individuals in their research and also detail how staff in the consortium will be supported with training opportunities and career development.
  • Provide evidence of how they have developed collaborations and strategic partnerships.
  • Evidence of impact they have had on policy and practice relevant to maternity inequalities.
  • Detail their approach to patient, public and community involvement and engagement and research inclusion.
  • Provide a summary of their previous research funding and outputs relevant to their proposed contribution to the maternity inequalities consortium.

Successful members of the consortium at this stage will each receive development/partnership funding (up to £50k) to facilitate their entry into the consortium and establish links with other consortium members. This funding may also be used for some initial rapid scoping activity.

Co-lead selection

The consortium will be directed by co-leads each sharing responsibility for leading the consortium. The co-leads will provide leadership and be accountable for the day-to-day operations.

Each successful application selected to join the consortium will be invited to nominate one candidate for co-lead. Candidates put forward will be interviewed and selected by DHSC.

Stage 2

The second stage will involve the development of a shared work business plan by all successful consortium members selected at stage 1. The plan will set out in detail the future research and capacity building programme of the consortium. The members will work together to formulate this innovative plan, describing activities and the resources needed to support these. The work plan will be submitted to the DHSC for approval and be reviewed by an external Delivery Group configured by the NIHR. Once this work plan has been approved by the DHSC, contracts will be signed, applicants will become full members of the consortium and the research and capacity building activities will commence.

Two contracts with one covering research and one covering capacity building will be signed with the co-lead. The co-lead will be responsible for organising sub-agreements with the wider consortium members and ensuring funding flows fairly and appropriately to enable delivery of the research and capacity building programme of work.

Timeframe

The timetable will be as follows:

  • 13 March 2024 – NIHR invites applications from suitably qualified organisations;
  • 22 May 2024 – Application submission deadline
  • June 2024 – independent expert selection committee reviews applications and provides recommendations to the DHSC on the Membership of the consortium
  • July 2024 – The DHSC confirms selection of consortium members
  • July - September 2024 - Successful members of the consortium will each receive development/partnership funding (up to £50k) to facilitate their entry into the consortium and establish links with other consortium members
  • July-September 2024 - Interviews and co-leads selection process
  • September 2024 to January 2025 – Work plan development
  • 2025 – Contracting process initiated
  • 2025- Commencement of research activity

Selection Criteria

The selection criteria at stage 1 will be:

  • The range and quality of relevant world-leading research relevant to tackling maternity inequalities and researchers at the organisation/across the collaboration.
  • The critical mass of expertise in maternity inequalities research and related disciplines.
  • The strength of the proposed collaboration (if applicable) and plans for appropriately distributing the funds within the collaboration.
  • The existing research capacity and plans for increasing research capacity; including evidence of commitment to training and career development progression at all career stages.
  • Evidence that the institution is committed to build research capacity over the award period and beyond to include:
    • in line with what is needed in maternity inequalities and
    • in broadening out to professions and communities that have traditionally had a low research base.
  • Evidence that the organisation/collaboration will provide a supportive environment for early and mid career researchers, including evidence that they have considered and taken account of issues related to equality, diversity and inclusion in supporting individuals research careers.
  • Evidence of the organisation/collaboration of collaborating with external researchers, organisations, decision makers, patients, public, community and practitioners to develop better evidence and achieve wider impact for maternity inequalities research.
  • The strength of prospective members’ strategic and ambitious plans to develop maternity inequalities research and capacity building, both within the consortium and more widely.
  • The strength of the strategic plan for patient, public and community involvement and engagement and research inclusion.
  • The relevance of the research for the broader stakeholders, such as local authorities, policy officials and other appropriate bodies.
  • The potential impact of the research, in relation to practice and policy.

The DHSC will determine the consortium co-leads based on the above criteria. The co-leads will need to demonstrate leadership and be at the forefront of their field, whilst their organisation will provide evidence of the above criteria and the ability to manage the contract successfully.

Monitoring

  • Members from the NIHR will be invited to all Executive Group meetings and commissioning meetings undertaken by the NIHR Challenge consortium.
  • The consortium is required to complete an annual report on progress and a final report at the end of the contract. Monitoring will be tailored to monitor the key aspects of the consortium and project delivery focusing on outputs against themes/project KPIs.
  • NIHR retains options for site visits including a review at the midterm point of the contract.
  • The focus will be on measuring performance against KPIs against selected themes/projects to ensure the research and capacity building programme leads to material changes in maternity inequalities.

Governance

  • The consortium will be directed by co-leads working with an Executive Group (formed from successful consortium members) responsible for the day-to-day running of the consortium.
  • The consortium will appoint an Advisory Group to provide comments and steer on development and undertaking of the work plan. Advisory Group members are external to the consortium Membership with an independent chair.
  • NIHR will convene a Delivery Group to monitor progress of the NIHR Challenge.