Timetable and Budget
| Description | Deadline/Limit |
|---|---|
| Deadline for Stage 1 applications | 14 February 2023, 1pm |
| Notification of outcome of Stage 1 application | April 2023 |
| Project start | July 2023 |
| Project duration | 9 - 12 months |
| Budget | £200,000 to £250,000 |
Due to the urgency of this research call, applications will be assessed through a fast-track single stage Committee assessment process, based on information provided in the outline stage 1 application form. Successful applicants will be invited to respond to Committee feedback in an expanded form and will directly proceed to contracting and project start-up.
Introduction
The National Institute for Health and Care Research (NIHR) Policy Research Programme (PRP) invites applications for a single research project to evaluate the impact of the adult social care provider information provisions under the Health and Care Act 2022. These provisions enable DHSC to obtain regular data submissions directly from adult social care providers.
The evaluation aims to understand whether the adult social care provider information provisions are an effective way of obtaining high-quality and timely adult social care data that is representative of all CQC-registered providers.
This is a significant opportunity to inform data strategy in adult social care to ensure that we collect data from social care providers which can be used nationally, regionally and locally to support the care sector and ultimately facilitate the care of individuals across the care system.
Background
Prior to the Covid-19 pandemic, DHSC had no comprehensive national source of data from adult social care providers with only annual data from local authorities collected by NHS Digital. The insight available was limited because it was only collected annually and in aggregate, generally six months in arrears and did not cover the entire adult social care market. The Health and Care Act 2022 has now, for the first time, provided a statutory mechanism that enables DHSC to obtain regular data submissions directly from adult social care providers.
As outlined in the People at the Heart of Care white paper, access to reliable data is key to underpinning the government’s ambition for social care reform. The Covid-19 pandemic has brought into sharp focus the need for high-quality data and information to be shared and used well. Emergency data measures taken in response to Covid-19 have given us near real-time data to manage the pandemic and has shown us the benefits of using data to respond to emerging risks and issues. Data from social care providers has been critical to the Government’s Covid-19 response and will continue to be crucial to help us to understand capacity and risk in the care system, to judge when and how to target support to providers and ultimately to help facilitate the care of individuals across the care system.
The Health and Care Act 2022 received Royal Assent in April 2022. It includes:
- A power for the Secretary of State for Health and Social Care to require adult social care (ASC) providers to provide information relating to themselves, to their activities in connection with the provision of ASC in England or to persons to whom they have provided such care (section 99).
- This power commenced on 31 July 2022 and applies to all ASC providers regulated by the Care Quality Commission (CQC). These are providers required to be registered under the Health and Social Care Act 2008 in respect of the carrying on of a regulated activity involving, or connected with, the provision of ASC in, or in relation to, England.
- A power to make regulations enabling the Secretary of State for Health and Social Care to impose a financial penalty on private providers that do not comply with an information request or provide false or misleading information without reasonable excuse (section 100).
- Regulations were made on 10 November 2022 and commenced on 1 December 2022. Enforcement regulations apply to all private ASC providers regulated by the CQC.
Full details of the core subset of data which providers are required to submit in the Capacity Tracker (CT) on a monthly basis are published in the Adult social care provider information provisions: guidance for providers on data collection. Capacity Tracker is a web-based data collection and insight tool which has been used by DHSC to gather data since Spring 2020.
Enforcement regulations can be used to impose financial penalties at the same level as a provider’s Care Quality Commission (CQC) registration fee, which is scaled to provider type and size. These enforcement powers are intended to be used as a last resort. A notice of intent will be given before imposing a penalty and the provider will have a right to make representations as to why it should not be imposed. A Final Notice imposing a financial penalty may then be issued. Providers will be able to request a review of the decision and/or appeal to the First-Tier Tribunal if they disagree with the decision made.
Research priorities
Research is needed to understand whether the adult social care provider information provisions are an effective way of obtaining high-quality and timely adult social care data that is representative of all CQC-registered providers. Specifically, the research should aim to answer the following research questions:
- What burden has complying with the mandatory data collection placed on care providers and how does this compare to the estimate made in the Impact Assessment [4]? What are the barriers and facilitators to care providers completing the data collection?
- Have mandation and enforcement been an effective means of increasing compliance? How often has enforcement activity been taken and at what stage of the enforcement process has it had the largest deterrent effect (e.g. informal warnings, notice of intent, final notice)?
- Have there been any unintended consequences of mandating and enforcing the data collection? For example, this could be in terms of the impact on the quality of the data collected, the ability of care providers to provide care and support to people in their care, or financial/resourcing implications for providers.
- How effective were the different communications around the data collection? This should consider communication relating to the initial mandatory data collection, subsequent changes to the mandatory data collection and the enforcement of the data collection. It should also consider the different communication routes, i.e. CQC Bulletin, DHSC care home manager newsletter, CT comms, etc as well as who in the provider should receive comms about data collection.
In answering all of these research questions, the research should consider how the findings vary for different types of care provider. The following characteristics should be considered, alongside any other characteristics that you feel are relevant:
- Provider location size and number of locations
- Services offered
- CQC rating
- Method of update for Capacity Tracker (e.g. direct upload using mobile phone, direct upload using laptop/tablet, bulk upload)
- Parent organisation (i.e. whether care providers are independent or part of a large parent organisation)
- Not-for-profit/commercial providers
- Geography, including region and urban/rural
- Compliance with mandatory data collection (i.e. how do views differ between those who have complied with the mandatory collection and those who did not comply and experienced the enforcement process)
We expect that these questions would be answered primarily using:
- Qualitative research with a broad range of adult social care providers, who are reflective of the population of CQC registered providers. The research should aim to speak to the registered manager at each location and/or the person or people that gather the data for Capacity Tracker. We expect this would be done using interviews, but applicants can propose the specific methodology most appropriate for this research, and we are open to alternative suggestions.
- This qualitative research should be supported by quantitative analysis of Capacity Tracker response rates and management information on enforcement activity. Contractors will be given access to the required data sets (including Capacity Tracker data and data on enforcement activity) for research purposes only. These data sets can be linked using CQC ID numbers.
DHSC will also share findings from internal quantitative analysis and qualitative feedback from care providers with the research team to help inform the evaluation and avoid duplication of work.
We are open to applicants’ views on the most appropriate methodological approaches to address the proposed research questions.
Expertise required
The NIHR welcomes bids from applicants from a wide range of different host organisations. The research team should have expertise in quantitative analysis of large datasets, conducting qualitative research and policy evaluation. Knowledge of the adult social care sector and experience conducting qualitative research with care providers would be preferable.
Outputs
Throughout the project, the team would be expected to have regular meetings with DHSC to discuss emerging findings. This is crucial to inform future policy on data collection from adult social care providers.
The team would be expected to share early insights, in the form of a briefing note, from the project with DHSC by December 2023. We expect this to report the progress so far and any emerging findings from work completed to this date.
Interim outputs are expected by the end of March 2024. These are needed to inform future policy on provider data collection. The form of the interim outputs will be discussed with the DHSC officials following contracting but is likely to include a briefing note for policy colleagues and a presentation both summarising the emerging findings from qualitative work with care providers.
Final outputs expected at the end of the project (within 9-12 months) include:
- A published evaluation report, including an executive summary suitable for use by policy colleagues to inform future policy decisions
- A presentation on the findings for key stakeholders
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 project resources needs to be flexible to meet these requirements. A meeting to discuss policy needs with DHSC officials will be convened as a matter of priority following contracting.
Budget and duration
Funds of up to £200,000 to £250,000 are available to support this work. 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.
The research should commence in July 2023 with final outputs within 9-12 months (i.e. before the end of July 2024). The team will be expected to share early insights from the project with DHSC by December 2023 and interim outputs are required by the end of March 2024 to inform future policy on data collection from care providers.
Management arrangements
A research advisory group including, but not limited to, representatives of DHSC, NHS Business Services Authority, the North of England Commissioning Support Unit Capacity Tracker team, and the successful applicants for the research should be established. 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.
Application
New Guidance on Inequities and 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 will now assess 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/or 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 will be worth considering whether it is possible to explore how inequalities may cause challenges for data collection, impact compliance and care providers’ experiences in relation to complying with mandatory data collection or the impact of any penalties or fines. When exploring inequalities, we would like researchers to focus on collecting responses from individuals with a range of characteristics. Characteristics to consider are: sex and/or gender, region, 5 ONS Ethnic groups, and the 5 IMD quintile groups. These characteristics are considered an ideal, but we understand that these are subject to change depending on the sample population and research design.
A recording of the Health Inequalities in NIHR PRP Research Q&A Event which was held on 19 September 2022 is available to view on Youtube, this may be useful to refer to as it provides additional information.
Further details about this new request can be found in Appendix A.
References and key documents
- Department of Health and Social Care. People at the Heart of Care: adult social care reform. [online]. DHSC: London; 2022 [Accessed 4 November 2022]. Available from: People at the Heart of Care: adult social care reform.
- Department of Health and Social Care. Adult social care provider information provisions: guidance for providers on data collection. [online]. DHSC: London; 2022 [Accessed 4 November 2022]. Available from: Adult social care provider information provisions: guidance for providers on data collection.
- NHS Commissioning Board, North of England Commissioning Support Unit (NECS). Capacity Tracker. [online]. NHS NECS; 2022 [Accessed 13 December 2022]. Available from: Capacity Tracker.
- Department of Health and Social Care. Mandatory provision of data by adult social care providers: impact assessment. [online]. DHSC: London; 2022 [Accessed 4 November 2022]. Available from: Mandatory provision of data by adult social care providers: impact assessment
Appendix A: 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. For other methodologies, variable vs number of observations may be more appropriate to record participant data). This table is for an example only. It does not contain sub variables and does not illustrate any preference for certain variables, as these will be dependent on the proposed research.
| 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 | - | - | - |
| Sex | - | - | - |
| Gender | - | - | - |
| Disability | - | - | - |
| Ethnic Group | - | - | - |
| IMD Group | - | - | - |
| Region | - | - | - |