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NIHR PGfAR DHSC Areas of Research Interest One Early Action To Prevent Poor Health Outcomes Competition Brief

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Published: 26 April 2024

Version: 1.0 May 2024

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Introduction

Established in 2006, the National Institute for Health and Care Research (NIHR) seeks to improve the health and wealth of the nation through research and is funded by the Department of Health and Social Care (DHSC) as described in Best Research for Best Health: The Next Chapter. Its funding programmes support high quality research in a broad range of topic areas that benefits the NHS, public health and social care.

In response to recommendations by 2015 Nurse review of the UK Research Councils UK government departments publish their areas of research interest to align scientific and research evidence from academia with policy development and decision-making. DHSC’s areas of research interest (ARIs) focus on areas of strategic policy importance to DHSC where research and innovation could facilitate a step change in how we deal with complex issues. The ARIs highlight to the patient, academic, clinical and life sciences community the areas where DHSC wants to expand its efforts and work together to systematically understand, intervene and improve public, patient and service outcomes.

DHSC has responsibility for the health of England and works with the devolved administrations of Northern Ireland, Scotland and Wales on many UK-wide priorities, including research funding. DHSC and NIHR also work closely with other funders such as UK Research and Innovation (UKRI), medical research charities, the life sciences sector and other stakeholders, and are working with these partners to deliver the new ARIs.

The aim of NIHR PGfAR is to deliver research findings that will lead to clear and identifiable patient, service user or carer benefits, typically through promotion of health and wellbeing, prevention of ill health, and optimal disease management (including safety and quality). Through a ring fenced funding call, PGfAR is now seeking to grow a portfolio of research programmes specifically designed to address the outcomes set out in DHSC’s ARI 1:

Early action to prevent poor health outcomes

Prevention, early diagnosis and appropriate intervention for people at increased risk of poor health (in particular obesity, cardiovascular disease, type 2 diabetes, mental health and cancer) to prevent excess deaths, improve population health (including the health of the working age population), reduce disparities and decrease reliance on health and social care.’

The portfolio will also seek to deliver applied research and innovation which addresses the cross cutting themes :

  • reduces health disparities and improves health and economic outcomes for the most deprived 20% of the population so that we raise the floor and not just the ceiling for the whole population
  • promotes economic growth by delivering a healthier workforce, a more efficient NHS, a more highly skilled health and social care workforce, and through investment in the life sciences sector
  • accelerates the adoption and scale of innovation in the health and care system’

This document sets out in detail the process for host organisations and their research collaborators to submit a PGfAR application to this ring fenced call.

Early action to prevent poor health outcomes

The following text is taken directly from the DHSC's areas of research interest webpage and is included in this call specification so that PGfAR’s broad aspirations are clear. In this call, we welcome ‘at-scale’ collaborative, multidisciplinary research applications that are clearly aligned with ARI1’s research objectives and are designed to generate relevant high quality research evidence ‘at pace’ on generalisable, early action approaches that improve outcomes for people with or at direct risk of common diseases. It is our intention to fund research which has a high likelihood of:

  • generating outputs that can be adopted at scale by health and care practitioners
  • informing policy development and decision-making, to enable system level improvements.

Suboptimal management of risk factors for common diseases (including hypertension, poor metabolic control, late detection of cancers and poor mental health):

  • drives morbidity and mortality
  • reduces the proportion of the population able to work and impacts healthcare delivery within the NHS and social care systems

Cardiovascular diseases, type 2 diabetes and many cancers are increasing in prevalence in the UK. For example, there were 5.8% more cancer diagnoses in 2019 compared to 2017 and diagnosed diabetes has increased from 2% of the population in 1994 to 7% in 2019, including sharp increases in those aged under 40 years. Mental health problems spiked during the pandemic, and in children and young people remain above pre-pandemic levels. Among 17 to 19 year olds, the proportion with a probable mental disorder increased from 17.4% in 2021 to 25.7% in 2022.

The costs to the individual, the health and care system and the economy are large. In 2022, around 2.5 million people in the UK were economically inactive due to ill health, an increase of 688,000 since 2019. Cardiovascular disease costs the UK economy £15.8 billion a year and the NHS £7.4 billion, while the NHS spent over £10 billion on diabetes care in 2019, with one in 6 hospital beds occupied by someone with diabetes.

Research is needed into how best to prevent disease, ensure timely diagnosis and develop appropriate interventions to prevent acute events and chronic disease. This could significantly improve health and economic outcomes for individuals, support a healthy workforce and reduce pressure on the NHS and social care. For example, preventative interventions and early diagnosis are estimated to reduce strokes, heart attacks and dementia cases by 150,000 over 10 years, saving £2.30 for every £1 spent. In England, more than 90% of people survive bowel, breast and ovarian cancer for at least 5 years if diagnosed at the earliest stage, and Cancer Research UK estimates the cost of treating late-stage colon, rectal, lung and ovarian cancer is nearly two and a half times the amount for early-stage treatment (PDF, 1.35MB). In England, early interventions for mental health problems can reduce hospital admissions, shorten hospital stays and require fewer high-cost intensive interventions potentially saving up to £38 million per year (PDF, 61KB).

Research objective

Research to understand and deliver prevention, timely diagnosis and appropriate intervention for people at increased risk of poor health (in particular obesity, cardiovascular disease, type 2 diabetes, mental health and cancer) to prevent excess deaths, improve population health (including the health of the working age population), reduce disparities and reduce reliance on health and social care.

Priority research topics

Developing, evaluating and understanding how to implement interventions which prevent health problems developing, accurately identify those at risk, effectively manage risk factors and treat conditions early, and manage health problems to prevent severe disease in the 4 areas set out below.

Prevent

Interventions to prevent health problems, developing effective routes to reach those who are most at risk or marginalised, and understanding how to effectively implement proven interventions at scale (for example, antihypertensives, mental health programmes for children and young people, vaccines for cancer or workplace preventative interventions).

Identify

New ways of identifying those most at risk (for example, predictive analysis of GP records to identify those who would benefit from early intervention, new methods of cancer screening and new approaches to diagnosing the causes of chest pains).

Treat

Interventions early in the course of disease progression (for example, social prescribing, early intervention for cancer or interventions to enable people to remain in or return to work).

Manage

Interventions to improve the management of multiple long-term conditions (for example, how to manage side effects in polypharmacy), prevent acute events (such as heart attacks, strokes and mental health crises) and ensure effective rehabilitation after these events to reduce long-term illness and disability.’

Outcomes

Across all ARIs, DHSC seeks research which improves both public, patient and service outcomes, such as the examples set out below.

Outcomes for the public and patients

These might include:

  • improved access to and experience of health services
  • improved physical health and mental health
  • improved quality of life and ability to work
  • reduced mortality
  • reduced health disparities

Outcomes for services

Improvements might include increased efficiency and reduced burden and costs across all parts of the care system from public health to GPs, ambulances, surgery and social care.

Priority cross-cutting methodologies

To deliver research and innovation which enable a step change in policy and practice, we need to expand capability and capacity and encourage interdisciplinary collaborations in specific research disciplines.

Systems thinking

Each ARI is a complex systems problem. Changing the status quo will only be possible by looking at all parts of the system, understanding how they connect, where they are amenable to intervention, and expanding the range of options available for solving the problem.

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 is needed to inform policy making, including realist reviews synthesising effects of interventions within complex systems.

Scope

Capitalising on the applied health and care research remit and scope of the PGfAR programme, we are participating in an cross-NIHR research programme ‘Early action to prevent poor health outcomes’ called by dedicating Competition 46, which will open in October 2024, to address the AR1 Priority Research Topics.

From Summer 2024 onwards, the NIHR research programmes and infrastructure will be running a series linked research calls on specific aspects of the DHSC ARI1 Priority Research Topics which will include (but not limited to):

  • Prevent: Development and implementation of scalable preventive interventions tailored to specific population groups or risk factors.
  • Identify: Research into new methodologies for early detection and risk assessment tools and stratification, including the use of emerging technologies and data-driven approaches.
  • Treat: Evaluation of early intervention strategies to optimise disease management, improve patient outcomes, and reduce healthcare costs.
  • Manage: Optimise the management of multiple long-term conditions, prevent acute events, facilitate effective rehabilitation post-events and promote long-term health and well-being.

PGfAR aim’s to fund at scale and pace, high-impact collaborative, multidisciplinary programmes of applied research that tackles one or more of these priority research topics areas to generate synergies that improve outcomes for the public, patients and services in the short term (0-10 years). Programmes that use relevant, DHSC’s priority cross-cutting methodologies to demonstrate patient, service user or carer benefits at an individual or population level are particularly welcome.

We welcome applications that present a coherent applied research programme of interrelated, multidisciplinary projects which individually and together produce outputs and outcomes that are likely to realise a step change in the health and care systems’ ability to act early to prevent excess deaths, improve population health (including the health of the working age population), reduce disparities and reduce reliance on health and social care.

Applicants to this PGfAR call will need to make the case that a coherent programme of research rather than a series of smaller more focused studies, would yield a comprehensive set of findings that could tangibly transform outcomes for the public, patient and services.

Our logic model summarises the core elements of the PGfAR programme and its portfolio of funded awards, visually representing the theory (i.e. ‘how it’s supposed to work’) of how a programme intends to bring about the desired benefits and changes in the health and care system and wider society. We recommend that applicants reflect on this portfolio level logic model, and consider how best to shape a programme of research to deliver outputs that can be readily adopted by the relevant health and care services, in particular in areas of high patient burden.

We want the applications we fund to create a balanced portfolio that is a strategic investment into practical and scalable approaches for prevention, timely diagnosis and appropriate intervention for people at increased risk of poor health. Therefore we encourage NHS bodies, public health and social care teams, and higher education institute research teams with established research track records in addressing common acute events and chronic disease, in particular obesity, cardiovascular disease, type 2 diabetes, mental health and cancer, to co-develop their application with the intention to work as a collaborative partnership to deliver a pipeline of implementable findings. We welcome collaborations addressing the innovative transformation needs of Integrated Care Boards, Systems and Partnerships in England, Scotland’s  Health and Social Care Integration Partnerships and Health Boards, NHS Wales’s Health Boards and Trusts, and Northern Ireland’s Health and Social Care Trusts.

In line with the UK Standards in Public Involvement and NIHR Research Inclusion strategy, meaningful patient, public involvement and engagement (PPIE) should be embedded within every stage of the research cycle. We are particularly keen to support established and emerging research partnerships with community and charity organisations and groups who can facilitate effective engagement of groups of people that are less well represented in research than would be desirable from population prevalence and healthcare burden. 

While remaining flexible, we aim to support applications that:

  • Identify and justify the health and care research context in terms of recent and currently funded research and policy in the UK and internationally.
  • Be conducted in geographical areas with a high need relative to the problem being studied.
  • Include team members residing in the high-need area of the subject under investigation.
  • Actively address barriers to engagement in research and co-production, such as disability and social exclusion. Collaboration with third sector and non-profit organisations dedicated to improving people’s lives.
  • Include and incorporate plans to build interdisciplinary applied research teams with relevant experience, to ensure research has potential to transfer into benefits to the health and care systems, patient, service users, carers and the wider public.

In line with the cross NIHR research programmes call, all research proposals will be expected to consider the following cross-cutting themes:

  • reducing health inequalities, such as the impact on equity and vulnerable populations, including intersectional issues
  • promoting economic growth in the broadest sense, including by delivering a healthier workforce, a more efficient NHS, a higher skilled health and social care workforce, and
  • through investment in the life sciences accelerating speed and adoption of innovation to tackle compound pressures

To ensure we fund awards with the potential to be transformative, we encourage applicants to reflect on how best to:

1. Learn from and build on the NIHR portfolio of funded research awards and infrastructure and equivalent applied health research portfolios in Northern Ireland, Scotland and Wales. ‘Acting early’ proposals that have public health, mental health or life course components would be expected to complement recent significant NIHR research investments, including:

2. Contribute to on-going and planned NHS and social care initiatives within the UK nations, for example:

3. For those applications which plan to investigate or develop digital innovations as part of their approach should be taken into account within their research designs and project plans:

As you prioritise your research ideas, we encourage you to consider the scale of challenges faced by the public and refer to population scale data and trends captured by the Office for National Statistics, National Records Scotland, and the Northern Ireland Statistics and Research Authority for example Rising ill-health and economic inactivity because of long-term sickness, UK: 2019 to 2023 and Health state life expectancies by national deprivation deciles, England: 2018 to 2020 

For more information about the types of research designs we will fund, we encourage applicants to refer to the ‘What we fund’ section of the main PGfAR webpage.

Eligibility

All NHS bodies and other providers of NHS services in England, Scotland, Wales and Northern Ireland may propose programmes, in collaboration with an appropriate academic partner or partners. Proposals may include support for patient/service user and carer groups participating in programmes of research. More details on eligibility can be found in the supporting information.  

Funding

The amount awarded and the length of the funding period depends on the nature of the proposed work. The standard for PGfAR awards is funding of around £2-2.5 million across 5 years but this call seeks to fund larger programmes, leading to a stepped change in outcomes and delivering at scale and pace, of between £3- £5 million across 5-7 years.

Applicants to PGfAR can include funding for academic capacity development and training, across all stages of the academic career pathway (i.e. from internships to Masters to PhD to post-doctoral). As a general rule, between 10% to 20% of the overall project programme grant budget can be spent on capacity building within the grant. More information can be found in the research capacity building guidance.

Selection Criteria for Applications

The PGfAR selection criteria used by the selection committee for this ring-fenced call include:

  • the relevant range of applicants' expertise in conducting high quality applied health and social care research
  • the importance and relevance of the proposed research to the priorities and needs of the NHS, public health, social care, patients, service users, carers, or the wider public and population
  • the likelihood of significant benefit to the NHS, public health, social care, patients, service users, carers or public throughout the programme
  • the quality of the research planned
  • the quality of involvement and engagement of patients, service users, carers in developing and supporting the research
  • evidence of attention to issues of equality, diversity and inclusion
  • the value for money provided by the application

The applicants for PGfAR ‘Early action to prevent poor health outcomes’ awards will be invited for interview by the selection committee as part of the commissioning process.

Process and Timetable

This ring fenced call will be conducted through PGfAR's two stage application process.  Proposals submitted via our online system are first assessed by the stage 1 subcommittee, and then shortlisted proposals are sent for methodological and public review. Stage 2 proposals are sent for peer and public review, before being assessed by the stage 2 subcommittees. For more information on how to apply, please take a look at our sample application forms and guidance linked on the main NIHR PGfAR page.

 Step

Open

Close

Stage 1 Call Launch

4 October 2024

 29 November 2024

Stage 1 Committee

Early January 2025

Stage 2 Call Launch

14 February 2025

10 April 2025

Stage 2 Committee

Early July 2025

Ratification and Outcome

Mid July 2025

Mid August 2025

Contract negotiations

Early September 2025

Mid December 2025

Research duration

January 2026

December 2033