This document provides guidance on completing an application for stage 1 of the NIHR Policy Research Programme (PRP) Post Implementation Review of the Health and Care Act 2022 research call.
Timetable and Budget
|Deadline for Stage 1 Applications||14 June 2022, 1 PM|
|Notification of outcome of Stage 1 Application||August 2022|
|Deadline for Stage 2 application||28 September 2022, 1 PM|
|Notification of Stage 2 Application||January 2023|
|Project Start||February 2023|
|Budget||Up to a maximum of £1,100,000 total budget, across multiple phases (including initial mobilisation / feasibility testing)|
The National Institute for Health and Care (NIHR) Policy Research Programme invites stage 1 applications for a single primary research project to provide evidence on the implementation and impact of the Health and Care Act 2022.
This is a significant opportunity to contribute to the evidence base on a high profile and important policy area of national policy.
System changes to promote collaboration between organisations providing health and social care which have evolved informally over recent years are to be formalised in law by the Health and Care Act. The Act puts in place a permissive, rather than prescriptive, framework which enables greater collaboration and allows Integrated Care Systems (ICS) to undertake activity which is best for their local context.
Our primary interest is to understand the different ways that ICSs and system partners (at system, place and neighbourhood level) are coming together to design, commission and deliver services, and their potential impacts and outcomes. The aim is to capture learning of these local arrangements: analysing and explaining how positive changes have been achieved, identifying potential obstacles, and highlighting how barriers may be addressed.
By integration we mean different partners in a system coming together collaboratively to make more joined-up commissioning and service design decisions. This research is concerned both with local arrangements that may continue or build upon previous initiatives, as well as new activity that has been initiated following the Act.
The main purpose of this research is to:
- Build-up a robust evidence base on, and a national and local picture, of efforts to deliver integrated care and support across the newly established Integrated Care Systems in England
- Spread learning in a timely manner, disseminating evidence of what works in commissioning, delivering quality integrated care and support)
- Support Ministers and policymakers understand how the system is evolving following the legislative changes, and so inform future policy development
- Provide evidence to help DHSC and other national organisations to better support ICSs
This study will need to harness and build on the extensive evidence base that has built up over recent years, as well as research that will soon commence including new NIHR commissions in this space. Successful applicants will need to coordinate with researchers on related projects to synthesise findings, but also help mitigate the potential interview or survey fatigue that ICB members, staff and people may experience from partaking in different studies.
Areas out of scope for this programme of work
The Health and Care Act covers multiple policy areas ranging from reciprocal healthcare arrangements to hospital food standards. Many of these clauses are enabling powers where impacts will only occur following the introduction of secondary legislation, regulations, or guidance. These ‘additional measures’, not related to system changes to promote collaboration, are not in scope for this project.
The evaluation will contain sub-projects. Researchers may approach the requirements by designing a series of work packages and/or projects that specifically address the aims and objectives of this research, as well as the priority policy and research questions.
We envisage this research as being a mixed methods and multi-phased study, taking place over at least 3 years. For illustrative purposes only, we have suggested a possible way of phasing this work below. However, applicants will be required to set-out full details of their proposals, along with a clear rationale, including sequencing of activity across different phases and study duration:
- Phase 1: initial process / formative evaluation, main stage feasibility testing, and finalisation of main stage plans
- Phase 2: main stage formative evaluation
Within this phased approach, a review of Phase 1 outputs and Phase 2 plans will be carried out before the main stage commences. This will provide the appointed evaluation team with the opportunity to refine their plans and adjust / reprofile the budget with DHSC before the main stage of the study commences.
The evaluation is expected to build in opportunities for feedback, and learning for policy makers. Applicants will be required to set out suggestions for how to maximise these opportunities.
This research is national in scope and needs to include all tiers of the reformed health and care system in England. We require a study which aims to understand how models of care are evolving at a system, place, and neighbourhood level, and captures the dynamics and contexts of different local areas.
The perspectives and experiences of a wide range of stakeholders and partners across the health and care system should be captured. Set out below are some suggestions for relevant actors. Applicants should confirm groups to be included, and how they will be identified and accessed:
- Integrated Care Board (ICB) leaders
- Integrated Care Partnership (ICP) leaders
- Senior managers of health system partners (statutory, independent, and community-based, including local authorities).
- This may include primary, acute, public health and community services and social care
- Representatives of place and provider-based collaboratives, and other statutory collaborative forums (Health and Wellbeing Boards)
- Frontline staff
- In-depth interviews with key national officials (DHSC, ALBs, OGDs) and national, local and key sector thought leaders.
Understanding the perspectives and experiences of people who use services, their family members and carers (including informal carers) is also critical for the study. Of particular interest will be groups that may use multiple health and social care services, since they are likely to be most affected by integration of services. We welcome suggestions from applicants on which people / groups would be best to include in the study to understand the research questions. We recognise that the people who may be most affected may also be the hardest to reach, and therefore applicants should recognise this and may want to demonstrate how they will reach these people. Examples might include the following (see also the Annex):
- People with multiple long-term conditions, particularly older people with frailty, who may use both social care and NHS services
- Children and young people with complex needs, including those eligible for education, health, and care plans.
While the Act covers a wide range of policy areas, only those elements that relate to system changes aimed at promoting collaboration should be the focus of this study. The table below lists a number of such themes, along with some example policy questions - the answers to which may help us understand if and how the system is evolving with respect to collaboration. This list is not exhaustive and is provided for illustrative purposes only.
Theme 1: Collaboration, leadership, and governance
- How are governance structures and leadership arrangements developing to facilitate co-ordination between the ICB and ICP, and between partner organisations (statutory, independent, and community-based, including local authorities), and places and provider collaboratives?
Supporting questions which may be considered when answering the overarching question:
- Do ICBs have due regard to the views of the ICP?
- Are ICBs and trusts considering the triple aim and the duty to cooperate in their decision making?
- How are local priorities being reconciled with wider system priorities?
- What has been the impact of the single accountable person on agreement of shared priorities/visible outcomes?
- In what ways does research and evaluation influence ICB decision making?
- What is the role and operation of provider collaboratives and place-based arrangements?
- What role has the establishment of the Provider Selection Regime played in enabling ICBs, local authorities, and providers of health care services to collaborate more effectively and deliver more joined-up services?
- What models to support leaders have developed in ICBs? How are systems and places learning from one another, how are leaders sharing knowledge and are there any emerging peer support systems?
Theme 2: Use of resources
- Are ICS partners working collaboratively to make better use of resources and improve value for money? How are they doing this?
- Can ICP/places influence ICB decisions on financial allocations?
- How efficiently ICSs able to allocate resources across sectoral boundaries?
- Are systems making use of joined-up/pooled budgets? How are they doing this and under which circumstances?
- Are ICP members working together to undertake joint workforce planning for their local areas? How are they doing this?
Theme 3: Experience of people and staff
- What differences in experience (satisfaction with services) and service utilisation can be observed across the system for groups most likely to benefit from improved collaboration?
- How are ICBs using information on peoples experience to influence decisions and work collaboratively?
Theme 4: Health and wellbeing inequalities
- How is the duty to tackle health inequalities embedded within the ICB governance structure?
- What mechanisms are being adopted by ICBs to reduce health inequalities? What impact is claimed?
The research team will be expected to provide regular progress reports over the lifetime of the research.
In line with our initial planning assumptions for project phasing, a report of findings should be provided at the end of Phase 1. The report will also include a full plan for research that will be carried out in subsequent years in the main stage. DHSC and partners will review this with the applicants and will agree the next phases of research.
A final report on the research, with an accessible executive and plain-English summary, will be required within one month following completion of the research.
Applicants are asked to consider the timing and nature of deliverables in their proposals. Policymakers 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 officials will be convened as a matter of priority following contracting.
Budget and duration
Reflecting the requirements set out in this document, and our planning assumptions on study phasing, the funding available for this research is as follows:
- Phase 1: initial process / formative evaluation, main stage feasibility testing, and finalisation of main stage plans – up to £300,000
- Phase 2: main stage formative evaluation – up to £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.
A research advisory group should be established including, but not limited to, representatives of DHSC and NHSE/I, and the successful applicants for the research. 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:
- Provide regular feedback on progress
- Produce timely reports to the advisory group
- Produce a final report for sign off
Research contractors will be expected to work with nominated officials in DHSC, its partners and the NIHR. 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.
Annex – further example groups for consideration
This section suggests suitable groups likely to be affected by the outcome locally of the reforms, who may provide a focus for research. For illustrative purposes, additional examples might include:
- 1,000 days (babies), who need holistic access for parents (midwifery, depression, health visitors) and multiple needs (access, safeguarding). Babies and parents may need access to multiple services.
- People with learning disabilities with high support needs, including those who are in institutional settings or at risk of being placed in these settings
- People with significant mental health needs, such as those eligible for the Care Programme approach or those who use high levels of unplanned care
- People with dementia
- People with rare conditions: they require highly specialised care and holistic care potentially in several locations or providers.
- People with undiagnosed conditions: readmissions data as system fails to diagnose their condition. Such individuals may use several services repetitively owing to ‘failure demand’ (using services repeatedly after needs not being met the first time)
- Inclusion health populations such as Gypsy, Roma and Travellers, homeless, prison leavers, vulnerable migrants, sex workers and armed forces veterans, which has particular relevance for health inequalities.