Policy Research Programme - (36-01-06) An Evaluation of the Oliver McGowan Mandatory Training on Learning Disability and Autism

Description	Deadline/Limit
Deadline for Stage 1 Applications	11 July 2023, 1 PM
Notification of outcome of Stage 1 Application	October 2023
Deadline for Stage 2 application	28 November 2023, 1 PM
Notification of outcome of Stage 2 Application	April-May 2024
Project Start	Within two months of award notification
Project Duration	36 months
Budget	£600,000 to £800,000 per project

Introduction

The National Institute for Health and Care Research (NIHR) Policy Research Programme (PRP) invites applications for a single research project to evaluate how the Oliver McGowan Mandatory Training on Learning Disability and Autism is being implemented in practice and the impact that the training has on people with a learning disability and autistic people, their family carers, staff, and trainers.

This evaluation will help to inform policy decisions for the Oliver McGowan Mandatory Training on Learning Disability and Autism in the future, including changes to the training to improve the content and delivery.
The evaluation will consist of two strands:

• A process evaluation to understand how the Oliver McGowan Mandatory Training on Learning Disability and Autism is implemented in practice, and whether the implementation meets the standards set out in the Code (expected to be published in late 2023).
  
  
• An impact evaluation to understand what effect the Oliver McGowan Mandatory Training on Learning Disability and Autism has on the health and wellbeing of people with a learning disability, autistic people, their family carers, and trainers, as well as the skills and knowledge of the staff.

Background

The Oliver McGowan Mandatory Training on Learning Disability and Autism is a training package developed by the Department of Health and Social Care (DHSC), NHS England, colleagues formerly part of Health Education England (HEE), Skills for Care, and co-developed by people with a learning disability and autistic people. The main objective of the Oliver McGowan Mandatory Training on Learning Disability and Autism is to improve the skills and knowledge of health and social care staff to provide safe, compassionate, and informed care to people with a learning disability and autistic people by ensuring that they receive appropriate training on learning disability and autism.

People with a learning disability and autistic people experience significant health inequalities. On average, people with a learning disability and autistic people suffer premature mortality from avoidable medical causes. Learning from Lives and Deaths: people with a learning disability and autistic people (LeDeR) produces annual reports giving information about the lives and deaths of people with a learning disability (and from autumn 2023, will also include the lives and deaths of autistic people) whose deaths have been notified to LeDeR. According to the annual LeDeR report in 2022, of all deaths among adults with a learning disability reported to the programme, “overall avoidable medical causes were 49% in 2021”, compared to 22% in the general population. It is also estimated that autistic adults die, on average, 16 years earlier than non-autistic adults [1]. Avoidable deaths include deaths that were preventable through public health and primary care interventions, those that were treatable by timely and effective health care and preventable through good social care practice, such as enabling people to adopt healthy lifestyle habits and effectively seek timely medical help.

These health inequalities are exacerbated by low understanding and knowledge of how to meet the needs of people with a learning disability and autistic people. Evidence indicates that health and social care professionals who do not work in learning disability services are not comfortable working with people with a learning disability [2] [8] and have a lack of knowledge and training to treat them effectively or communicate with them [7]. This is a large barrier to people with a learning disability and autistic people attempting to access healthcare and social care services [3] and can lead to diagnostic overshadowing and poor care[4] [8]

The Oliver McGowan Mandatory Training on Learning Disability and Autism is a vehicle for culture change and aims to is expected to improve the health inequalities experienced by people with a learning disability and autistic people, by increasing the knowledge and improving the attitudes and skills of healthcare and social care staff who treat and interact with them.

The Health and Care Act 2022 introduced new regulations for service providers that carry out Care Quality Commission regulated activities to ensure their staff receive training on learning disability and autism appropriate to their role and specified that the Secretary of State must issue a code of practice about compliance with the new regulations. The Code of Practice (the Code) is a set of standards and related guidance for service providers to know how to provide learning disability and autism training to their staff. The Oliver McGowan Mandatory Training on Learning Disability and Autism is the Government’s preferred and recommended training package that meets these standards and this is set out in the Code. It is named after Oliver McGowan, whose death shone a light on the need for health and social care staff to have better training. It is the only training with permission to include Paula McGowan OBE telling Oliver’s story and explaining why the training is taking place.

DHSC invested £1.4 million in 2020 to develop and evaluate a range of training packages to create two standardised packages named after Oliver McGowan. The development and preliminary evaluation was led by HEE and SfC. The National Development Team for Inclusion (NDTi), in partnership with My Life My Choice and Bemix), published a report of this evaluation. Based on these findings, the Oliver McGowan Mandatory Training on Learning Disability and Autism has been designed as follows across two packages:

• Tier 1 package is designed for those who require a general awareness of autistic people and/or people with a learning disability. It is delivered through a 1.5-hour e-learning module and a 1-hour interactive webinar led by a co-trainer with a learning disability, a co-trainer who is an autistic person, and a facilitating trainer.
  
  
• Tier 2 package is designed for those who provide care and/or support for autistic people and people with a learning disability. It is delivered through the same 1.5-hour e-learning module and a 1-day face-to-face training led by a facilitating trainer, a co-trainer with a learning disability, and a co-trainer who is an autistic person

Further information on the development of the Oliver McGowan Mandatory Training on Learning Disability and Autism can be found in Annex A

The roll-out of the Oliver McGowan Mandatory Training on Learning Disability and Autism has started in stages. In October 2022, the e-learning module was released. All staff across health and social care can access this via their NHS Electronic staff records. ICBs have begun building capacity by recruiting co-trainers with a learning disability and autistic co-trainers and facilitator trainers to deliver the Oliver McGowan Mandatory Training on Learning Disability and Autism. HEE started running trainer preparation sessions in December 2022 for Tier 1. Tier 2 trainer preparation sessions started in early 2023. It is expected that funding will be provided to roll out the Oliver McGowan Mandatory Training on Learning Disability and Autism for both NHS and social care providers.

Research priorities

The overall objective of this research is to evaluate the implementation of the Oliver McGowan Mandatory Training on Learning Disability and Autism and to understand what the impact has been on people with a learning disability and autistic people, their family carers, staff, and trainers.

The intended benefits of the Oliver McGowan Mandatory Training on Learning Disability and Autism have been estimated through a theory of change (though this is not intended to be comprehensive). This has been included in Annex B. We would like to know if the outputs and activities in the theory of change were achieved in line with the Code standards. We would also like to know if the outputs and activities produced the desired training and service outcomes and influenced the shorter and longer term impacts, and whether there have been any unintended impacts. Researchers are not expected to address all outputs included in the logic model, it is included to give researchers an idea of the various outcomes and impacts that could result from the training.

We anticipate that the evaluation will consist of two strands. Below we have outlined research questions that DHSC and partners are interested in. We are open to suggestions for additional topics and questions for inclusion in the research. Further information on how we anticipate applicants to approach these research questions will be available at the specification webinar.

The first strand aims to understand whether the Oliver McGowan Mandatory Training on Learning Disability and Autism is being implemented as expected and as set out in the standards of training in the Code (process evaluation).

Key research questions we would like to answer within this strand include:

• Are staff receiving/taking up the training as intended across NHS, adult social care and private sectors? (If not, why?)
• Is the Oliver McGowan Mandatory Training on Learning Disability and Autism being delivered in line with the standards set out in the Code? To what extent is the Code being followed?
• What can we learn from how the Oliver McGowan Mandatory Training on Learning Disability and Autism is delivered to meet the standards set out in the Code and how can that learning be used to improve future delivery?
• What improvements could be made to the training to ensure the Oliver McGowan Mandatory Training on Learning Disability and Autism is being delivered as intended?

Research questions within this strand may also include (but are not limited to):

• What are the different mechanisms for delivery across Integrated Care Boards (ICBs), NHS, private healthcare and adult social care?
• Are there any practical barriers that are preventing the delivery of the Oliver McGowan Mandatory Training on
• Learning Disability and Autism? If so, what are they? If so, how could these be overcome?
• Are there costs/benefits associated with these different mechanisms for delivery across the NHS, privately funded healthcare and adult social care?

The second strand aims to understand the impact of the Oliver McGowan Mandatory Training on Learning Disability and Autism on people with a learning disability and autistic people, their family carers, staff, and trainers (impact evaluation):

Key research questions we would like to answer within this strand include:

People with a learning disability and autistic people

• Does the Oliver McGowan Mandatory Training on Learning Disability and Autism meet its policy objective such that people with a learning disability and autistic people are provided with safe, compassionate and informed care? Are there specific impacts, for example, in service experience?
• Is there evidence that the Oliver McGowan Mandatory Training on Learning Disability and Autism contributes to a reduction in health inequalities (e.g., avoidable deaths, diagnostic overshadowing, DNACPR) experienced by people with a learning disability and autistic people? If so, in what ways and to what extent can this be attributed to the training?
• Has the Oliver McGowan Mandatory Training on Learning Disability and Autism had any unintended/unanticipated impacts on people with a learning disability and autistic people? If so, what are they?

Family and carers of people with a learning disability and autistic people

• What are the specific impacts on the family carers who support people with a learning disability and autistic people?

Trainers

• What are the specific impacts on the co-trainers with a learning disability and autistic co-trainers?

Staff

• What impact does the Oliver McGowan Mandatory Training on Learning Disability and Autism have on staff (including their behaviours, communication skills, knowledge and confidence towards people with learning disabilities or autistic people)?
• Does the Oliver McGowan Mandatory Training on Learning Disability and Autism lead to cultural and organisational change in health and social care settings towards people with learning disability and autistic people?

In addition, we are also interested in the following questions for staff:

• Are there any unintended consequences for staff who do not primarily support people with a learning disability and autistic people in undertaking the Oliver McGowan Mandatory Training on Learning Disability and Autism tier 1 package? If so, what are they?
• Are there any unintended consequences for staff who primarily support people with a learning disability and autistic people in undertaking the Oliver McGowan Mandatory Training on Learning Disability and Autism tier 2 package? If so, what are they? Do these differ from the benefits of those who do not primarily support people with a learning disability and autistic people?

Methodology

We anticipate a mixed-methods approach, including both qualitative and quantitative data, to inform the process and impact evaluations. We remain open to suggested methodologies proposed by the applicant that best address the requirements of this evaluation. We have outlined below considerations to guide an application.

Co-production

• DHSC has committed to involving people with a learning disability and autistic people in the development, delivery, and evaluation of the Oliver McGowan Mandatory Training on Learning Disability and Autism. There is an expectation that researchers will co-produce the research where appropriate alongside PPIE (Patient and Public Involvement and Engagement) members, including in the design of the evaluation.
• Researchers should acknowledge that people with a learning disability and autistic people have a variety of distinct experiences and consider how they would reflect that in their research design.
• All proposed methodology (e.g., questionnaires, focus groups, interviews) should be accessible for people with a learning disability and autistic people. This may include, for example, producing Easy Read versions of documents.

Sampling

• The evaluation should include samples of staff (from all adult social care providers who have started rolling out the Oliver McGowan Mandatory Training, both regulated and unregulated), the family carers for people with a learning disability and autistic people, and trainers (including Experts with Lived Experience).
• Sampling of staff should be representative of the various sectors receiving training – this includes dentists, social care, NHS hospital staff, private healthcare providers and private social care providers. Sampling of people accessing support services should also be representative from all services receiving the training.
• Sampling should also be geographically varied, with samples from urban and rural health settings and all areas of the UK.
• When measuring improvements in knowledge, skills, communication, and attitudes, it would be beneficial to include some objective measures, in conjunction with rather than relying on solely self-report measures, e.g., performance reviews, observations or peer reviewing.
• External factors which could impact the research should be considered in the methodology, for example, how high staff turnover in the health sector could impact research design.

Data collection and analysis

• We anticipate the impact evaluation will need to collect baseline data from participants in the training, trainers, and people accessing support services at the beginning of the research period. This could include both qualitative and quantitative data. DHSC developed a logic model and theory of change to set out anticipated outputs and outcomes from the Oliver McGowan Mandatory Training on Learning Disability and Autism. These will be shared with successful applicants as a basis to develop a fuller theory of change and help identify possible metrics for measuring the impact of the training. The original methodology could then be repeated later in the evaluation to allow time for impacts to develop, but we invite other suggestions for capturing longer-term impacts.
• NHS England will share standardised pre- and post-training questionnaires with service providers and encourage them to send the questionnaires out to training recipients in the NHS. A similar model will be deployed for adult social care, and both organisations will make these available to the independent evaluation partners as a data source for the evaluation.
• A key consideration during the development of the evaluation should be the disaggregation by staff groups at both a macro (i.e., health care and social care) and micro level (i.e., administrative staff, learning disability nurses, social care workers who work directly with people with a learning disability, social care workers caring for people over 65, A&E, primary care, etc.). Groups of people accessing support services should also be disaggregated at macro level (e.g., people with a learning disability and autistic people) and at micro level (e.g., inpatient, community care, hospital outpatient, residential care, domiciliary or supported living etc.).
• We would be interested to understand the effects of intersectionality within the group of people accessing support services, for example, how the impacts of the Oliver McGowan Mandatory Training on Learning Disability and Autism might differ for different groups of people with a learning disability and autistic people, e.g., different ethnicities, gender, and severity of learning disabilities.
• Though pre- and post-training questionnaires will be sent to training participants by training providers, we would expect researchers to supplement these with questions specific to the evaluation and collate this data for analysis.
• We expect that the research will be reliant on analysis of pre- and post-training feedback questionnaires and primary data, however we are also open to any proposals to do secondary data analysis if there are datasets available that researchers consider useful for the purpose of the evaluation, including the use of clinical and social care notes.

Out of scope

Research is not required to evaluate any training programmes being carried out in Devolved Administrations or any further training programmes for learning disabilities and autism. The only training programme that is in scope is the Oliver McGowan Mandatory Training on Learning Disability and Autism, even if other training programmes meet the Code standards.

Expertise required

The applicant should be able to demonstrate the following:

• Expertise in undertaking complex evaluations and designing and conducting and analysing large scale mixed methods research projects.
• Expertise in learning disabilities and autism research – including experience collecting primary data with people with a learning disability and autistic people and the co-production of research alongside Experts with Lived Experience.
• Knowledge of the social care and NHS system.

Outputs

Applicants are asked to consider the timing and nature of deliverables in their proposals. Policymakers and delivery partners will need research evidence to meet key policy decisions and timescales, so resource needs to be flexible to meet these needs. A meeting to discuss policy needs with DHSC, NHS England and social care representatives will be convened as a matter of priority following contracting.
Outputs should include:

1. A full project plan including an initial Gantt chart at the beginning of the research process to be shared with DHSC and other stakeholders;
2. Interim reports and updates as agreed at project scoping, as required, and to meet policy making timelines;
3. Publishable reports of interim findings at key milestones (i.e., at the end of the process evaluation) and a final publishable report, with an executive and lay summary, for the impact evaluation and process evaluation;
4. Reports should be available in accessible formats to suit a range of audiences, including easy read versions. This includes all reports, including interim reports;
5. Other summative outputs (such as policy briefings), if required, to disseminate the findings across the range of stakeholders (including for NHS England and social care);
6. A number of presentations of findings to DHSC colleagues and key stakeholders from other government departments and arms-length bodies, and Experts with Lived Experience where required, including for interim reports;
7. Access to the raw data from the research at the end of the research period for DHSC colleagues to use in further policy decision making (this is desirable, but not essential)

Budget and duration

Applications will be assessed on value for money, we would expect them to cost between £600,000 - £800,000.

Costings can include up to 100% full economic costing (FEC) but should exclude output VAT. Applicants are advised that value for money is one of the key criteria that peer reviewers and commissioning panel members will assess applications against.

At this stage, we would expect the research project to be completed by late 2027 to provide detailed and useful insight for a review of the training and policy development. Interim reports are expected throughout this period in a form suitable for busy policymakers and include easy read formats.

The expected durations are as follows:

• Strand 1 (Process evaluation):
  i) Should begin in 2024 as soon as possible following award notification. We expect it to finish in 2025 with preliminary findings reported in 2025.
• Strand 2 (Impact evaluation):
  i) Alongside collecting the baseline primary data, the researchers should also review secondary data supplied by NHS England to feed this into the baseline.
  ii) Baseline data collection should be started in 2024 as soon as possible following award notification. We expect preliminary findings to be reported in 2026.
  iii) Impact data collection is expected to begin from 2025/26. It is expected that the final report should be published in late 2027, in time for the Code review, 5 years after the initial Code publication.
• Privately funded healthcare employers may follow a different rollout timeline to that followed by the NHS and social care employers, therefore applicants may have to consider staggered timelines when collecting data from private employers.

Though the duration of each evaluation project is not fixed, it is important that the start and finish dates for the overall research project meet policy need. Applicants are encouraged to set out their own estimates for the timing and cost for each phase, based on their specific proposals. The researchers should build in contingency planning into their bid, so resources can be deployed flexibly to mitigate any issues with data collection. Sufficient time for ethical approval to be obtained should be considered.

Management arrangements

DHSC will establish a research advisory group including, but not limited to, representatives of DHSC, NHS England, social care representation and Experts with Lived Experience, and the successful applicants for the research soon after the research has been awarded. The advisory group will provide guidance, meeting regularly over the lifetime of the research. The successful applicants should be prepared to review research objectives with the advisory group, and to share emerging findings on an ongoing basis. They will be expected to:

• Clarify the roles and responsibilities of the researchers involved to provide clear understanding of each person’s involvement in the project.
• Provide a secretariat to the advisory group, record meeting minutes, maintain an action log and schedule meetings with stakeholders.
• Provide regular feedback on progress.
• Produce timely reports to the advisory group.
• Produce a final report for sign off, including an easy read version.

Research contractors will be expected to work with nominated officials in DHSC, its partners and the NIHR. Nominated contacts should be provided to DHSC for day-to-day enquiries.

Any communications activity around the findings from the evaluation will need to be done in partnership with the Oliver McGowan Mandatory Training on Learning Disability and Autism communications team. This includes the co-ordination of communications around published outputs, press releases and any other communications activity.

Key documents including, for example, research protocols, research instruments, reports and publications must be provided to DHSC in draft form allowing sufficient time for review. This time to review should be factored into project timelines at the beginning of the research process. Review timelines are estimated to take a month.

People with a learning disability and autistic people are key to this research and researchers are expected to co-produce the evaluation alongside them. Applications without active involvement from the learning disability and autism community will not be successful.

It is recommended that applicants complete the Oliver McGowan Mandatory Training on Learning Disability and Autism e-learning course to understand the format and content of this part of the training when designing their bid for the evaluation. It is available for the public to complete.

New Guidance on Health Inequalities data collection within NIHR PRP Research

Inequities and inequalities in the provision, access to and experience of health and care services is a high priority area within the Department of Health and Social Care and the NIHR and is present in the majority of funded projects. We are now assessing all NIHR research proposals in relation to health and care inequalities. NIHR asks researchers to explore issues of inequality and inequity in the research being proposed. 

Our goal is also to facilitate more widespread and consistent reporting of data on health and care inequalities relating to the primary outcomes of NIHR funded research. Applicants should, if feasible, collect or analyse data related to health and/or care inequalities, we request that this stated in the proposal. This is a new request from the NIHR PRP and we will be continuing to monitor queries and make any necessary clarifications, as needed.

We understand that research projects may employ different methodologies, and focus on different populations. We ask that you please clearly identify in the research plan section of the application whether your application has a health and care inequalities component. If the project uses quantitative methods, please include detail of the core set of data that will be collected or analysed. Submission of the data collection will be a condition of final reporting that will need to be submitted to NIHR PRP when the grant has finished. If a health and/or care inequalities component is not included, please explain clearly why this does not fit within your research.

Specifically for this project, it may be useful to consider whether any particular groups are particularly impacted by discharge delays, and whether interventions have any differential impact for different groups. This may include consideration of local / regional variation, deprivation or characteristics covered by the Equality Act.

A recording of the Health Inequalities in NIHR PRP Research Q&A Event which was held on 19 September 2022 is available online, this may be useful to refer to as it provides additional information.

Further details about this new request can be found in Annex C

References and key documents

1. University of Bristol. Learning Disabilities Mortality Review (LeDeR) Programme. Annual Report. 2018. Available from:The Learning Disabilities Mortality Review (LeDeR) Programme
2. Ee J, Kroese B A, & Rose J. A systematic review of the knowledge, attitudes and perceptions of health and social care professionals towards people with a learning disability and mental health problems. British Journal of Learning Disabilities, 2021;00:1-17. Available from: A systematic review of the knowledge, attitudes and perceptions of health and social care professionals towards people with learning disabilities and mental health problems
3. Afia et al. Discrimination and Other Barriers to Accessing Health Care: Perspectives of Patients with Mild and Moderate Intellectual Disability and Their Carers. 2013, PLoS One, 2013;8(8):e70855. Available from: Discrimination and Other Barriers to Accessing Health Care: Perspectives of Patients with Mild and Moderate Intellectual Disability and Their Carers - ProQuest
4. Mencap. Death by indifference. Following up the Treat me Right! report. 2007. Available from: Death by indifference
5. Department of Health and Social Care. ‘Right to be heard’: the Government’s response to the consultation on learning disability and autism training for health and care staff. 2019. Available from: ‘Right to be heard’: The Government’s response to the consultation on learning disability and autism training for health and care staff
6. NDTi. Evaluation of the Oliver McGowan Mandatory Training Trial in Learning Disability and Autism. 2022. Available from: Evaluation of the Oliver McGowan Mandatory Training Trial in Learning Disability and Autism
7. Corden K, Brewer R, & Cage E. A Systematic Review of Healthcare Professionals’ Knowledge, Self-Efficacy and Attitudes Towards Working with Autistic People. Review Journal of Autism and Developmental Disorders, 2022;9:386-399. Available from: A Systematic Review of Healthcare Professionals’ Knowledge, Self-Efficacy and Attitudes Towards Working with Autistic People | SpringerLink
8. Unigwe et al. GP’s confidence in caring for their patients on the autism spectrum: an online self-report study. British Journal of General Practice, 2017;67(659):e445-e452. Available from: GPs’ confidence in caring for their patients on the autism spectrum: an online self-report study - PMC
9. Crane L, Davidson I, Prosser R, & Pellicano E. Understanding psychiatrists’ knowledge, attitudes and experiences in identifying and supporting their patients on the autism spectrum: online survey. BJPsych Open, 2019; 5(3): e33. Available from: Understanding psychiatrists' knowledge, attitudes and experiences in identifying and supporting their patients on the autism spectrum: online survey - PMC

Annex A: Background information on the development of the Oliver McGowan Mandatory Training on Learning Disability and Autism.

Existing provision of training to staff on meeting the needs of people with a learning disability and autistic people is not consistent or effective. While training on learning disability and autism is available, provision and uptake is low among health and social care staff and organisations. In 2019, HEE commissioned and Skills for Care published the Core Capabilities Framework for Supporting People with a Learning Disability and the Core Capabilities Framework for Supporting Autistic People to set out the essential capabilities necessary for health and social care staff. However, there was no specific regulatory requirement to demonstrate use of or compliance with the frameworks, and a lack of consistency and quality of training has remained an issue cited among health and social care staff in training. The current training on learning disability and autism has not resulted in a reduction of avoidable deaths in these communities or improved health and care outcomes.

The Oliver McGowan Mandatory Training on Learning Disability and Autism was developed to ensure a consistent and effective training offer for staff. The training is named after Oliver McGowan, an autistic teenager who, in 2016, was admitted to hospital with partial focal seizures, was prescribed antipsychotic medication and died. Oliver was intolerant to this medication and his parents believe his death could have been prevented. A LeDeR investigation also concluded that Oliver’s death was potentially avoidable. Oliver’s parents campaigned to introduce mandatory training on learning disability and autism for healthcare and social care professionals. In 2018, the Government accepted the recommendation made in the second annual LeDeR report to introduce mandatory training to all healthcare and adult social care staff. In 2019, DHSC consulted on proposals for introducing such training, which incorporated training on autism. The Government published its’ consultation response, ‘Right to be heard’, which laid out the Government’s commitment, including funding to develop the training package.

Annex B: Theory of change for the Oliver McGowan Mandatory Training on Learning Disability and Autism

• Inputs – legislation that makes training on learning disability and autism statutory for health and adult social care staff working in settings that carry on CQC regulated activities; accompanying code of practice that outlines how such training should be delivered; and expenditure on training.
  Activities – training sessions and their components (i.e., completion of e-learning module, online webinar, face-to-face session).
• Outputs – number of trained health and adult social care staff working in settings that carry on CQC regulated activities.
• Training outcomes – increased staff knowledge; increased ability to recognise people with a learning disability and autistic people; better skills in working with them; better ability to communicate in an accessible way; more positive attitudes.
• Service outcomes – higher provision of reasonable adjustments; reduced diagnostic overshadowing; reduced overprescribing of medication; reduced use of restrictive practices; higher involvement of people accessing support services in their own treatment and wider care choices.
• Shorter-term impacts – more positive experiences of care provision; higher engagement in preventative public health and primary care interventions; more effective health care treatment and more adherence to treatment and care; improved support to help people manage their own health better.
• Longer-term impacts – reduced avoidable admissions and shorter hospital stays, especially for ambulatory care sensitive conditions; lower rates of overmedication; reduced prevalence of preventable medical conditions; earlier medical interventions with less intensive treatment; better management of morbidity rates; increased cancer screening attendance rates; higher levels of wellbeing among people with a learning disability and autistic people, as well as their family and carers; reduced mortality associated with avoidable medical causes of death.

Annex C: Further Detail on the New Guidance on Health Inequalities data collection within NIHR PRP Research

Health Inequalities is a high priority area within the Department of Health and Social Care and the NIHR and is often present in a majority of funded projects. We are now assessing all NIHR research proposals in relation to health inequalities. We are asking applicants to identify in their application whether or not there is a health inequalities component or theme and how this research hopes to impact health inequalities. We are also asking researchers to collect relevant data related to health inequalities, if appropriate for the research. Collecting specific information about health inequalities in research submitted to the programme will allow for categorisation of health inequalities research, curation of data to aid future health inequalities research and enable policymakers to better understand the implications of health inequalities within their policy areas. This is a new request from the NIHR PRP and we will be continuing to monitor queries and adapt the process as needed. If you have any feedback on this new request, please contact us at prp@nihr.ac.uk. 

Our goal is to facilitate more widespread and consistent reporting of health inequality breakdown data relating to the primary outcomes of NIHR funded research. We would ideally like researchers to focus on the following equity-relevant variables: age, sex, gender, disability, region*, 5 ONS Ethnic groups**, and the 5 IMD quintile groups. These variables are considered an ideal, but we understand that these are subject to change depending on the sample population and specific research question.  

For qualitative research projects, this can be purely baseline characteristics of the participants, for example, the number of participants in each ethnic group. 

For quantitative research projects, if there are multiple outcomes/effects with your stakeholders, select a small number of main outcomes as appropriate to report equity breakdowns. We will not be prescriptive about the number of the outcomes, as it will depend on the number of study design types and the nature of the project aims. We are asking for one way cross tabulations of each primary outcome by these equity-relevant variables, if appropriate for your research, together with the number of observations in each cell. If more detailed cross tabulations are appropriate for your proposed research, please include these as well. This request applies to both primary data collection studies and secondary analysis of routine data, and to causal inference studies as well as descriptive studies; however, if this is not possible due to data limitations then please explain. Due to sample size and other data limitations there may be difficult scientific and/or data security*** judgement calls to make about which breakdowns to report and whether to merge categories to increase counts in particular cells; we ask you to make these judgments yourself, bearing in mind our data curation aim of enabling future evidence synthesis work in pooling results from different studies. We also ask that researchers report breakdowns for the unadjusted as well as adjusted outcomes/effects, as appropriate.

We understand that research projects may employ different methodologies, and focus on different populations. Please explain how the variables and data collection methods chosen are appropriate to the methodologies used. 

We ask that you please clearly identify in the research plan section of the application whether your application has a health inequalities component or not and detail the core set of health inequality breakdown data that will be collected, if applicable. Submission of the data collection will be a condition of the final report for all research with relevant methodologies regardless of whether the research has a health inequalities component that will need to be submitted to NIHR PRP when the grant has finished. This should only take a few sentences within the research plan section. 

* Table below uses the nine regions in England, further regions can be used if using the UK as the study population. Please report region breakdown for large samples in nationally representative descriptive studies. There is no need to report this for small sample studies, for sub-national studies, or for quasi-experimental studies where it would require time-consuming re-estimation.

** White, Mixed/ Multiple ethnic groups, Asian/ Asian British, Black/ African/ Caribbean/ Black British, Other ethnic group. If the sample size is small then it is fine to report only some of the requested equity breakdowns and to merge some of the sub-groups as appropriate.

*** For guidance on how to handle data security concerns in reporting of sensitive data please see ONS guidance.

Example data table for submission at the end of the funded research project

(N.B. If there is more than one main outcome then you will require more tables and if you adjust your outcome then you will need two tables for the adjusted outcome and unadjusted outcome):

Variable	Outcome (an appropriate average for this subgroup, usually the mean)	Number of observations	Additional information about variation if appropriate, e.g. range, standard deviation
Age	0	0	Additional information
Sex	0	0	Additional information
Gender	0	0	Additional information
Disability	0	0	Additional information
Ethnic Group	0	0	Additional information
IMD Group	0	0	Additional information
Region	0	0	Additional information

The Oliver McGowan Mandatory Training Evaluation Webinar Q&A

The time for measurable impact is likely to be long. What is the funding timescale please?
Researchers should include what they believe to be feasible in terms of assessing impact within the time period of the evaluation, which could include any interim measures. DHSC will need the findings from the evaluation by December 2027, in time for the Code of Practice 5-year review.

Can you provide greater clarity about the expected outcome of the training, so that more fine-grained evaluation can be planned?
We have produced a theory of change in appendix B of the research specification specifying some of what we could expect to see from the training. We would like to hear from applicants which longer-term outcomes can be feasibly assessed and the method to be employed within the time frame of this evaluation.

Is it possible to have access to the standardised NHS pre- and post-training questionnaires?
We are in the process of developing these with NHS England. In the meantime, we advise you go to the Appendix document of the NDTi Oliver McGowan Mandatory training evaluation report. 

Is it possible to access and use LeDeR data in the context of the evaluation?
The LeDeR reports are free for the public to access. LeDeR has s251 approval from the Confidentiality Advisory Group for service improvement only, not research. As the evaluation would be considered to be research, you would not be allowed access to the data. If researchers would like further clarification, they would need to contact LeDeR researchers directly.

One of the research questions for strand 1 states "What are the different mechanisms for delivery across Integrated Care Boards (ICBs), NHS, private healthcare and adult social care?"; could you clarify what is understood by "mechanisms" here?
The word “mechanisms” is used here to describe the way the training is rolled out to staff, which staff are invited to complete each tier of training, and whether the training is being delivered in-house or by a third party.

Please could you explain a bit more what you mean by ‘longitudinal’ (i.e., are you wanting to track participants over time, or do you mean a long-term evaluation that measures before/after impact)?
In this case, we would like to conduct a long-term evaluation looking at the impact on people with a learning disability, autistic people, staff, trainers, family and carers before and after the implementation. We are not looking to track participants over time. If, however, researchers would like to put forward a methodology that tracks participants over time, we would be open to this.

What is the scale of the Oliver McGowan Mandatory Training, and do you expect to include everyone in the evaluation, or just a sample?
The Oliver McGowan Mandatory Training is intended for all healthcare and social care staff in regulated services across the public and private sectors. Rollout times and delivery mechanisms may differ between sectors. We expect to only include a sample in the evaluation which can be disaggregated by key staff groups (see the specification for further detail on this).

Have you thought about how the population/sample will be contacted (i.e. would the training deliverers be sent links to disseminate - if so, how would this be co-ordinated at scale - or would there be a centralised mailing list provided to the evaluators)?
We do not currently collect contact information for people who complete the training. We expect applicants to include recruitment strategies in their proposal.

Have you done a Power calculation to estimate sample size?
No, we have not. If researchers wanted to conduct a power calculation, they could include this in their bid.

Should we be considering a question about whether the training works?
We know from the trial evaluation that the training has a positive impact on knowledge, skills, and confidence for staff. This research is concerned with the breadth of possible shorter-term and longer-term impacts – by asking what impact it is having, we are asking whether it is having no impact, a small impact or a large impact for any of the populations included in the evaluation.

Do you have an agreed sampling matrix or agreed measures of impact to be used in the evaluation?
No, we are remaining open to any ideas applicants have on the methodology to be used for sampling or the measures used for the impact evaluation. We look forward to receiving proposal from applicants about the best methodology to use in this evaluation.

Do you want the Experts with lived Experience to co-produce the research? How do we rule out unconscious bias from them?
Yes, we would like Experts with Lived Experience to co-produce the evaluation. This could be through a Patient and Public Involvement and Engagement (PPIE) group, for example, or an advocacy group. Unconscious bias is an issue for all researchers, and we would expect to see within the proposal how this will be addressed.

Has the Autistica Health planning review been looked into before making the call?
The Autistica Health planning review was published in June 2023, which is after the specification was published, however, the findings in the report and recommendations support the reasoning behind the Oliver McGowan Mandatory Training.

Did the evaluation look at the implications of organisations/systems actually operationally delivering this and the overarching cost needed/involved which both are key challenges?
A trial evaluation was completed as part of the development of the Oliver McGowan Mandatory Training which considered the implications and challenges of implementing this training. As a part of the policy development, an Impact Assessment has been developed to complement the Code of Practice. It will be published alongside the Code of Practice this month for the Consultation and we aim to publish the final Impact Assessment in early 2024.

Will there be an EOI call first?
This is a two-stage standard application process managed by the NIHR Policy Research Programme (NIHR PRP). Stage 1 applications comprise an outline of the proposed work. Shortlisted applications will then be invited to submit full stage 2 applications. 

Where can we find the stage 1 application documents?
All application details can be found on the NIHR PRP call post. Research proposals are submitted online through the Research Management System, but there is also a MS Word version of the Standard Application Form available for download under “Supporting Information” to allow off-line preparation of the application form content. Any questions should be directed to prp@nihr.ac.uk .

Are you expecting a lot of applicants for this and if they are of insufficient quality, will you take a different approach to funding this evaluation?
This is an open call and we cannot comment at this stage on how many applications we will receive or the quality of applications. We hope that the guidance provided will help applicants to submit high quality fundable applications.

The following questions are less related to the evaluation process and more related to policy .

Can advocacy/service user groups put forward a desire to work in co-production with successful applicant?
Applicants are responsible for appointing their own research team, including PPIE (Patient and Public Involvement and Engagement) members. Research awards are published on the NIHR funding and awards website  once contracted so interested collaborators can find the details of successful applicants.

How will quality be measured? Who will be interviewed as part of the research? Will value for money be considered i.e. cost to implement versus outcomes?
It will be up to the applicants to include in their application how they will collect data and from who. DHSC is not looking for a value for money evaluation – we are only looking to commission a process evaluation and impact evaluation at this time.

How are you ensuring co-production is part of both the bids invited and the process/panel members evaluating them?
DHSC and NHSE have committed to co-producing the Oliver McGowan Mandatory Training with people with a learning disability and autistic people. The research specification was co-produced with people with a learning disability and autistic people and we expect researchers to build co-production into their evaluation applications. Applicants should demonstrate in their application how they can make information accessible to people with a learning disability and autistic people, including by providing an accessible version or summary of their application.

The NIHR PRP funding committee includes lay representatives, who will assess all applications . As indicated in the applicant guidance and in the NIHR PRP Standard Information for Applicants. PPIE is expected to be a key element of research applications and the NIHR PRP funding committee will be looking for evidence of PPIE at every stage of the proposed work from development through to dissemination.