Area of Research: Economics of Health and Social Care Systems
Section 1: Summary of main strands/themes for research
This Unit aims to apply methodologies and approaches from a range of economic areas (though not the exclusive preserve of this discipline) to inform a better understanding of the interactions between and within health care and social care so that: a) policies for one part of the system take account of interdependencies and impacts across systems; and b) evidence can be gathered on how health and social care systems and policies for this can achieve desired objectives more efficiently.
The work programme will be developed in consultation with policy makers and analysts. It is suggested to focus on both the common issues facing the health and social care system as well as the interaction between different areas of the system - especially in the context of the development of Integrated Care Systems (ICS) and Boards (ICB) (though many of the topics will overlap). The Unit will need to retain the ability to respond to emerging and rapid policy requests.
Main themes for research include:
- Drivers of demand for health and social care, including community health services, and associated activity and spending, macroeconomic modelling of the drivers of demand, activity, need and expenditure and their relative strength. Including considering the role of prevention and public health in changing / influencing these drivers
- Continued recovery from COVID-19, including understanding and mitigating its impact on health and care systems.
- Integrated Care Systems, understanding organisational workingandcollaborationmodelsandidentifylearnings. Including alignment of incentives, efficiency of expenditure, effectiveness of overall system design.
- This could include examining patient flow through the system under the ICS model.
- Supply side efficiency and managing met and unmet demand, interdependence between health and social care services.
- This could include applying economic understanding to wider reform and specific changes in service delivery, such as examining the comparative value for money offered by different elements of community health services.
- Understanding and addressing inequalities in the delivery of health and social care services, focusing on those aspects which are within the gift (wider determinants will be addressed in other PRUs).
- Productivity, within the health and care system as a whole and in its constituent parts – considering allocative efficiency as well as technical productivity.
- The economics of social care, in particular, the economics of the interface of social care and health systems.
The Unit will require the ability to draw in a number of economic disciplines and apply them to the health and care systems and to be applied to cross-cutting issues across health and care (for example mental health, dementia and other long-term conditions/multiple long-term conditions).
Section 2: Details of policy context and background
Management of the NHS, acute and community care and social care system costing over £180bn is part of the core business of DHSC. Using the discipline of economics is critical to better inform public policy understanding of the interaction between health and social care, as well as the underlying drivers of activity and expenditure and the role of policy levers in the system.
The Health and Social Care Integration white paper, published in Feb 2022 outlines the plans for supporting the integration of health and social care to ensure services are planned, commissioned and delivered in a joined-up way to support people to live healthy, independent and dignified lives and improve outcomes for the population of a whole - . The social care white paper, People at the Heart of Care outlines a 10-year vision for transforming support and care in England. Economics research and analysis will be important in supporting the implementation and evaluation of system reforms. The work of the Unit will also support the delivery of the NHS Long Term Plan.
New treatments for the growing and ageing population alongside the growing number of people with multiple long-term conditions (MLTC) means pressures for services are expected to increase. Understanding the interaction between different aspects of the health and care system, from primary care and acute services to social care, is important to aid policy development based on evidence of these complex interactions.
Sustainability of the health and care system, as well as maintaining a good quality of care designed around the needs of the individual and society, relies on effective working between areas of the system and a strong evidence base. Systematic barriers and poorly aligned incentives can create disjointed commissioning of health and social care, having consequent impacts on other areas of the system.
Section 3: Justification for research topics
A research programme is required to help answer the themes set out in Section 1, in the context of the pressing policy questions confronting the nation, set out in Section 2. These themes represent the scope of issues from which the final agreed programme will be built. Findings from this programme will provide the longer-term evidence base needed to support the Department’s key long-term goals, particularly in an environment of resource constraints.
Section 4: Other related research activity of which the Unit will need to be aware
The Unit will build on research activity undertaken within the Policy Research Programme to date and will be expected to link with other PRUs, where their work has implications for that area of research and/or vice versa. In particular, it is anticipated the Unit will work closely with the Economic Methods of Evaluation in Health and Social Care Interventions, Adult Social Care and Health and Care Systems and Commissioning units.
The Unit may also need to make links with other Call-off Analytical Facilities that have been commissioned to undertake rapid and urgent research as well as with wider NIHR programmes. The unit will be particularly responsive to high priority cross-cutting policy issues as they emerge from the DHSC.
The work of this unit will need to be set within the context of the wide-range of NHS activity including that of NICE and the support for building the evidence-base through programmes of research through NIHR. It will be important to establish a clear focus on the broader strategic policy issues that will be required by DHSC.
The Unit should also be aware of the work of other funders and organisations interested in this space to ensure complementarity.
Section 5: Other issues relevant to this programme of research
Long-term reform of the health and care system and addressing the strategic challenges are likely to be a continual focus. The evidence will be needed to feed in to key cross government reviews and periodic events such as the Spending Review.
Potential applicants will need to demonstrate a commitment to responding quickly and effectively to reactive areas of work as required. The Unit will be required to work with a range of stakeholders in DHSC, its Arm’s Length Bodies and the wider health and care system as appropriate.