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 | within 2 months of outcome notification (subject to pre-contract negotiations) |
| Project Duration | Developmental phase: 6-9 months Following completion of this developmental phase, funding may be offered for a main study (estimated duration 18-24 months) |
| Budget | Developmental phase: £100,000 - £150,000; estimate value for follow-on main study: £300,000 - £500,000 |
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 the development phase of a multi-phase research project to build the evidence around ‘what works’ to support unpaid carers by evaluating the use and impact of support for unpaid carers funded through the BCF. This includes funding earmarked specifically for support for unpaid carers (c£290m in 22/23: this may vary in future years) and any further discretionary spend by local areas.
This research should include:
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A. A development phase consisting of:
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A review to understand and map the range of activities and decisions taking place to support unpaid carers within the Better Care Fund, including what, how and why funding decisions are made locally, and their intended outputs and impacts. This should be considered within the context of the wider evidence base on support for unpaid carers.
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Provide options and recommendations for how (a selection of) these activities could be evaluated, considering relevant factors which might include data availability, methodological deliverability, and criteria for selecting activity to evaluate.
Initial outputs from this first stage (A) will be required by the run-up to the next Spending Review, expected summer 2024. Please see paragraph 17a and 17b for more information on research questions.
B. An evaluation to be conducted following the development phase that provides evidence on the impact of activities to support unpaid carer services within the Better Care Fund and builds the evidence base on ‘what works’ to support unpaid carers
Applicants are invited to submit plans and costs for the development phase of the research. Since the development phase will inform the main study, it is recognised that it will not be possible to set out full details of the evaluation yet.
This phased approach enables a flexible commissioning process, with opportunities for applicants to refine plans and costs. Further details of the commissioning process are set out below.
This research aims to inform local and national understanding and decision-making around the commissioning and delivery of effective care/support services for unpaid carers within the health and care system. It aims to inform future policy to improve outcomes for unpaid carers.
Background
Better Care Fund
The White Paper People at the Heart of Care sets out ambitions for a 10-year journey of reform of Adult Social Care.?Central to delivering this vision is promoting and embedding services that respond to rising demand and the changing needs of English population; to make person-centred care & support a reality.
The Better Care Fund (BCF) is one of the Government’s principal levers in driving forward the integration of health and social care in England. It requires Integrated Care Boards (ICBs) and local authorities to make joint plans and pool budgets for the purposes of integrated care, providing a context in which they can work together, as partners, towards shared objectives.
The BCF budgets reflect that cooperation, with the Government committing at least £7.7 billion to support this joint working and local areas free to contribute further voluntary contributions.
Unpaid Carers Funding within Better Care Fund
Unpaid carers perform a key role in the Adult Social Care system, providing an estimated annual social benefit of £57-132bn across the UK (2;3). Whilst not directly comparable, this contribution far exceeds the current costs of formal state-funded adult social care.
Each year, the NHS contribution to the BCF includes funding to support unpaid carers breaks and funding for the implementation of the Care Act 2014 duties, such as on carers support. Funding is intended to provide support to carers by offering access to short breaks, respite services and additional advice and support. Its inclusion in the BCF supports an integrated approach to the delivery of health and care services.
In 2022/23, the BCF funding earmarked for carers is ~c.£290m. This earmarked funding is not ringfenced within the BCF and local areas must agree the amount of funding available in their locality that will be committed to support carers. As a result, actual spend by local authorities on services to support carers may differ and other funding sources of the BCF are in practice used for supporting carers. The earmarked allocation may vary in future years.
The 2022/23 BCF Framework ensures that all local BCF partnerships set out how funding is being used to support unpaid carers. The Framework provides the parameters of the Fund for the year ahead, including details on funding, national conditions, and metrics for the BCF.
Planning requirements for 2023/4 - 2024/5 will be published in March 2023 with the expectation that local areas will agree and provide their spending plans by late spring. Local area plans will be provided for 2 year (2023-25) and will include:
- Carers support scheme information – this includes details of agreed spend against the different activities planned to support unpaid carers. This information is provided within pre-set scheme types (e.g., unpaid carers) and sub-types (e.g., respite care) and will include a short description of the purpose of individual funded activity.
- Narrative plans – These narratives provide further detail on the local areas approach to integrating health and care services and their high-level objectives for the year, how they will make progress against the programmes objectives, and how pooled funding from the BCF supports these objectives. Within these narratives, areas describe their approach to supporting unpaid carers and how BCF funding will contribute.
- Outputs – Subject to final decisions, it is expected that information may be collected on the outputs of different types of spend by local areas, (e.g., X spend on respite care will support y number of unpaid carers).
- National outcome metrics - this provides local area data for four national outcome metrics; effectiveness of reablement, admissions to residential and care homes, avoidable admissions to an acute hospital and hospital discharges to a person’s usual place of residence. These are collated from various data sources (e.g., ASCOF) within an annual report which describes how many HWBs are meeting their locally set targets.
Research priorities
The overarching aim of this multi-phase research study is to better understand the use and impact of BCF-funded support for unpaid carers (including earmarked funding and any additional local spend) and to build the evidence around ‘what works’ to support unpaid carers. This research will improve local and national understanding and decision-making around what and how to commission and deliver effective care and support services for unpaid carers and will inform future policy to improve outcomes for unpaid carers within the Adult Social Care system.
The initial development phase is focused on mapping and understanding how current activities taking place to support unpaid carers within the BCF are funded and delivered in practice. It is anticipated that an output of the development phase will be recommendations for a robust evaluation that sets out how to evaluate these activities. The later impact evaluation will focus on building the evidence around ‘what works’ to support unpaid carers within the Adult Care System.
Research questions of interest for the initial development phase are:
a. Mapping of current unpaid carer activities:
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Which unpaid carer activities are currently funded with the existing BCF money?
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How many carers do they support?
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How and why are local areas allocating funding to (different types of) unpaid carer activities?
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What variation is there in the amount and types of funding across local areas?
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What are the intended outcomes or impacts of unpaid carer activities funded through the BCF?
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What conclusions, if any, can be drawn on the impact of current activities?
b. Scoping of impact evaluation
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What data is available to evaluate the impact of these activities?
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What data is required and needs to be collected for an impact evaluation? How can data requirements be met?
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Which unpaid carer activities could feasibly be evaluated?
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Which outcomes and impacts can be assessed?
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What methods and approaches are needed to evaluate the impact of unpaid carers activities? (this will likely include a proportionate approach focusing on selected case studies or activities. The scoping should consider how this selection should be approached.)
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How can local areas (including ICBs) be engaged to support the evaluation and ensure that it is relevant and impactful?
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How can outputs from the evaluation be effectively disseminated to local areas to inform their decision-making?
Methodology?
We expect that the initial development phase will include multiple work streams to provide insight into the commissioning, delivery and potential impact of the current activities taking place to support unpaid carers within the BCF.
Analysis is needed to understand and map the use and impact of activities supporting unpaid carers funded through the BCF. Evidence is needed on the scale, breadth, types of funded activities, their expected impacts and outcome measures. This is anticipated to involve secondary analysis of the information and data collected by local areas through the BCF programme, including annual local area strategic narratives, carers support scheme information, output and outcome measures and data, and spend data.
Analysis of the existing information and data collected through the BCF programme will need to be considered in relation to the current evidence base for support for unpaid carers. Contextualising activities in this way is expected to enable the identification and selection of funded activities to build the evidence around ‘what works’ to support unpaid carers. A review of existing evidence will provide understanding on:
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the extent to which current funded unpaid carers activities reflect the evidence base in practice
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the extent to which current spend on unpaid carers activities follows the existing evidence base in practice
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where and which evidence gaps exist for the different activities taking place to support unpaid carers activities
Qualitative engagement with stakeholders, such as local BCF leads, directors of commissioning, service leads and VCS representatives, is needed to further understand how and why funding decisions for activities taking place for unpaid carers are made by Integrated Care Board and Health and Wellbeing Boards. This may include exploring how the delivery of the BCF influences Integrated Care Board and Health and Wellbeing Boards’ decision-making and commissioning approaches, the extent to which evidence influences funding decisions and the barriers or challenges to incorporating evidence into decision-making and commissioning processes.
Triangulation of the evidence from the secondary analysis, evidence review, and interviews is expected to further understanding of the use and impact of the c.£290m (and any additional local spend) unpaid carer funding within the BCF and enable the research team to assess the feasibility of, and make recommendations for, future impact and process evaluation.
Evaluation of unpaid carer activities within the BCF is needed to build the evidence around ‘what works’ to support unpaid carers within the Adult Care System. We expect that recommendations will be based on consideration of current and future data requirements, the types of outcomes that can be assessed and will identify (or set out a framework for the identification of) possible BCF funded activities that can be robustly evaluated. Recommendations should also set out an approach for working with local areas to enable them to engage, and potentially participate, in any future evaluation. It should similarly set out the types of outputs from the evaluation that local areas indicate as most relevant to their decision making and how these have been incorporated into the evaluation approach, and how evaluation outputs can be effectively shared with local areas. We expect any evaluation approach to set out what can be achieved over the short and longer term.
Commissioning Process
We invite proposals using the NIHR PRP Stage 1 form specific to this call. At this stage, applicants are required to submit their plans and costs for the development phase of the project. Since this will inform the main study, we recognise that it will not be possible to set out full details of the main study. However, applicants are required to describe how they will manage and deliver the main study.
The development phase study will be commissioned via a one-stage process. The funding decision will be informed by advice from the Policy Research Programme funding committee.
On completion of the development phase, applicants will be required to set out a plan for the main study and an indicative budget. This plan will be assessed by independent experts and a judgement will be made regarding the next stages of research and whether to proceed. It is possible that the development phase of research will conclude that a main study is not possible or deliverable within the available research budget. The decision to progress will be subject to independent expert assessment of the development phase, including the proposed approach to the main study, and budget approval.
Should the development phase conclude that a main study as proposed is not feasible, an output of the development phase could be an alternative proposal achieving the aims set out here for the main study. Any such alternative proposals will similarly be subject to assessment by independent experts and DHSC officials, on whether and how to proceed.
Expertise required
Applicants should be able to demonstrate the following:
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Strong understanding of the social care sector in England
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Expertise in conducting complex evaluations of national policy programmes
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Expertise in conducting quantitative and qualitative research and analysis
Applicants may wish to engage with the NIHR Research Design Service (RDS). The RDS provides free and confidential advice on research design, writing funding applications and public involvement, to health and social care researchers across England.
Outputs
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.
Analysis from the development phase and impact evaluation must be shared with DHSC officials.
Key outputs from the development phase should include:
- an end of development phase workshop
- an end of development phase report detailing:
- analysis of current unpaid carer services funded through the BCF, including:
- secondary analysis – such as a typology of unpaid carer activities and their intended impacts, and review of available data to support these
- summaries and conclusions from the evidence review – such as the extent to which current funding reflects the evidence base in practice and where evidence gaps exist,
- key themes identified from qualitative engagement with stakeholders – such as an overview of how and why funding decisions are made and any barriers to incorporating evidence-based decision-making.
ii. methodological approaches that have been considered for the larger impact evaluation
iii. a recommended approach for the design of the main evaluation or options for the design – this will likely involve a proportionate approach focussing on case studies or a sub-set of activities. The report should detail how selection of any case studies or activities should be approached, and should consider current data availability and future data needs
iv. any recommendations for changes to data collections in future years
Regular meetings are also required throughout the duration of the multi-phase study to provide DHSC officials with updates from the research and provide any interim outputs
Evidence from the initial development phase is required by Summer 2024 to be incorporated into the Spending Review 2024/5
Evidence from the impact evaluation will be needed to inform the next BCF planning round and local decisions.
Budget and duration
Funding is available for both phases of research set out in this document. At this stage, we anticipate commissioning a development phase study costing up to £100-150,000. Our current planning assumption is that a subsequent main study will cost between £300,000 and £500,000.
For current planning purposes, we expect the development phase to take between 6 - 9 months. Applicants are asked to describe the work anticipated in the development phase in detail, providing an accurate estimate of the cost for delivering this development phase specifically. This figure should be entered in the application as the estimated research cost.
The duration of the main study will need to be considered considering the development phase. We estimate that the main study could take up to an additional 18-24 month. This timetable is not fixed; applicants are asked to set out their own indicative estimates for the timing and costs anticipated across the different phases of the project (this information can be included within the narrative research plan section of the application), based on their specific proposals.
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.
Management arrangements
A research advisory group including, but not limited to, representatives of DHSC, other stakeholders (including NHSE, ADASS, LGA, Carers UK, Carers Trust, SCIE), 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.
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.
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 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 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.
When exploring inequalities, we would like researchers to focus on collecting responses from or about 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. Given the nature of this project, looking at inequalities related to region or geography may be most appropriate. DHSC is open to applicants’ suggestions on how to approach inequalities for this project.
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
1. Department of Health and Social Care, People at the Heart of Care: adult social care reform white paper, 2021.
2. Office for National Statistics, Unpaid carers provide social care worth £57 billion, 2017.
3. Carers UK, Valuing Carers 2015 – The rising value of carers’ support, 2015.
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 | - | - | - |