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Policy Research Programme - Working Age Research Specification (3rd iteration)

Published

14 December 2021

Version

1.0 - December 2021

Contents

Timetable and budget

Description

Deadline/Limit

Deadline for stage 1 applications:

18 January 2022

Notification of outcome of stage 1 applications:

March 2022

Deadline for stage 2 application:

03 May 2022

Notification of outcome of stage 2 applications:

August 2022

Project start:

September 2022

Budget

£250,000 to £750,000 per project

This research specification was used in the 2018 competition to fund NIHR Policy Research Units. A unit on developing the evidence base for policy aimed at improving health and wellbeing, and reducing health inequalities, for people of working age was not commissioned. 

This document is provided to inform discussions around the scope of a new NIHR Policy Research Programme funding call on research to improve health for people of working age. This is to ensure that the new funding call is focusing on priority areas and asking appropriate questions, such as does it look to be addressing the most relevant themes? How would it need to change to become a new NIHR call?  

Introduction 

1. The NIHR Policy Research Programme (PRP) invites applications to undertake research on working age health to support Government policy around work, health and disability. Research is invited on the following themes:

  1. Understanding population needs in relation to employment and health among working age people: rich descriptions of populations and their needs that can inform policy assumptions.
  2. Supporting participation in good work for people experiencing sickness or who have long term health conditions or disabilities: research that could lead to the improvement or development of activities aimed at supporting disabled people and those experiencing ill health that affects their ability to work, to remain in work, or re-enter work where that is beneficial for their health. 
  3. Trends, new developments and delivery models where there are implications for health and work intervention or service design, and/or health and work outcomes; new ways of approaching health and work intervention or service design and delivery.

2. Research projects funded by this call will provide further evidence to inform policy aimed at improving health and wellbeing and reducing health inequalities by investigating the relationship between health and work, and generating knowledge about effective interventions. As such, research commissioned through this call is expected to be largely non-clinical in nature. Funded projects will need to generate results to inform policy in the next three to five years.  

3. Proposed research studies will need to demonstrate relevance to the issues outlined in this specification and demonstrate the potential to:

  • Influence a range of stakeholders (e.g. Department of Health and Social Care and Arm’s Length Bodies, Department of Work and Pensions, National Health Service England, Clinical Commissioning Groups, Primary Care Networks, local government, employers/industry);
  • Inform improvements to policy and practice with widespread population impact; 
  • Support strategic improvements (e.g. more effective integration across health and employment systems, better investment decisions); 
  • Recommend interventions or policies that could be sustained medium to long term;
  • Improve societal and system preparedness for future health and wellbeing challenges.

4. We are seeking projects with a high potential for impact and wide applications and benefits across the working age population. You may find the NIHR Impact Toolkit useful. Proposed studies should have potential to contribute to improvements in population health and reductions in costs to the economy, health and welfare systems of ill health that prevents people working, through a focus on:

  • Work as a health determinant - improving health through work and workplaces; 
  • Reducing sickness absence and supporting return to work; or
  • Reducing work incapacity and supporting employment and re-employment.

5. Applications must clearly state how the proposed project will deliver policy relevant findings and impact at the end of the funding period, even if the project comprises part of a longer term programme of work.

6. Projects may draw on a range of methodologies including: evidence reviews, secondary analysis of quantitative and qualitative data, primary data collection including qualitative research and evaluation studies.

7. Health and work issues occur in a complex system which crosses the boundaries between health settings, the workplace, and the welfare system. Successful outcomes require collaboration between many different actors including individuals, employers, healthcare professionals and other service delivery professionals. Studies will therefore need to have clear plans for involvement of these actors. Proposals must include a stakeholder engagement plan and consider opportunities for coproduction, and demonstrate that projects are feasible in the time available. In this call, key study participants may be employees or employers rather than NHS patients and therefore plans should be appropriately targeted at the study focus and research objectives. Although applicants must still include the usual NIHR required 'Patient and Public Involvement' section in their proposals, it is recognised that for this call responses can focus on the most relevant groups for the research proposed (e.g. employees, employers), and this may not include NHS patients.

8. Applications will be considered from any type of organisation and from other UK countries (Scotland, Wales and Northern Ireland) provided they address the priority areas in a way that is relevant to the needs of the Department of Health and Social Care (England) and meet all other selection criteria. There are no restrictions on who can fulfil the role of lead applicant or principal investigator. For more information about application requirements, please see the 'Standard information for applicants' section below.

9. Applications will be assessed according to the criteria listed in paragraph 6 of the 'Commissioning Process' information below.

Background

10. Long term health conditions and disabilities are prevalent among working age people. In the UK, there are around 13.9 million working-age people with a long-term health condition, including 8.2 million disabled people whose condition limits their ability to carry out day to day activities.[1] Most commonly, working age people are affected by mental health or musculoskeletal problems - 7 in 10 working age disabled people have a mental health or musculoskeletal health condition, either as their main condition or alongside other health conditions.[2]

11. Over the course of a year, around 1.4 million working-age people have at least one long-term sickness absence lasting four weeks or longer: this is around 4% of those in work or have been in work in the last 12 months. Most people successfully return to work after a period of long-term sickness absence, and many return relatively quickly.[3] However, people with disabilities are 10 times more likely to leave work following long-term sickness absence than people without disabilities, and people with disabilities who are unemployed are around three times less likely than people without disabilities to enter employment over the course of one year. Sickness and health-related worklessness have negative effects on quality of life and income for individuals and their families and may exacerbate health problems. Ill health which prevents people working also costs the economy an estimated £100 billion a year including £7 billion to the NHS.

12. A range of evidence discussed in the Marmot Review[4] demonstrates that employment is a key social determinant of health with implications for health inequalities. There is now a substantial evidence base demonstrating the harmful effects of unemployment on health and a growing literature indicating both the features and importance of good work for physical and mental health and wellbeing. Good work provides psychosocial, material and physical benefits, while poor work environments can result in ill-health.[5]

13. Based on clinical evidence, there is also now a broad consensus across stakeholder groups (including researchers, disabled people’s representative groups, and employers) that when their health conditions permit, people with health conditions or disabilities should be encouraged to remain in or (re)-enter work as soon as possible.[6] Evidence shows work can be therapeutic for people with health conditions or disabilities, leads to better health outcomes and minimises the harmful effects of long-term sickness absence and the risk of long-term incapacity.[7]

14. A series of independent reviews and government policy documents have considered the opportunities to intervene, in workplaces and through the health and welfare systems when health problems pose a risk to individuals staying in work or when people with long-term health conditions or disabilities need support to enter jobs.[8,9,10]

15. Most recently, the Government has set a goal to see one million more people with disabilities in work between 2017 and 2027, and has set out national policy measures to encourage employer action to prevent ill-health related job loss, for example by developing the private market of occupational health support.[11] The Government has also invested in a significant programme of testing and trialling promising health and work interventions. 

16. In the health system, recent institutional developments are changing the opportunities to support patients who may be struggling to stay in, or re-enter work due to health problems. Integrated care systems now enable local governments and the voluntary sector to work together to reduce health inequalities, such as the disability employment gap. In addition, expanded multidisciplinary teams within primary care networks are better able to offer complementary forms of support to address needs that affect work participation.

Evidence needed for policy making

17. While there is a wide research literature on the two-way relationship between health and work, policymakers often struggle to pinpoint specific evidence to inform real-world policy approaches and improve services at scale. Debates about action on health and work can range from discussions about promoting health and safety in the workplace through to the best means of employment support for long-term incapacity benefits claimants. While the issue of health and work is broad, the policy need for this call is research that will inform measures or support to help working age people who are struggling to remain in work or re-enter work due to health reasons to achieve those goals, to thereby improve the health of working age people.   

18. Policymakers in this area also need a variety of different types of evidence to help with making a case for action, such as design of specific measures that can be replicated (for example considering the target groups and scope, as well as specific details of an intervention); cost-benefit assessment (according to Green Book principles), and real world implementation.

Scope

Populations of Interest

19. The population of interest for this call is the working age population in its broadest terms – people aged 16-64. However, we recognise that when taking a lifecourse approach these boundaries should not be set in stone, and may need to cover slightly younger or older age groups. 

20. For particular topics or issues it may be relevant to consider the entire working age population. For other topics or issues, it may be more relevant to consider a more specific population, for example, people with long term health conditions or disabilities, or people on sick leave and at risk of falling out of work, younger or older workers. However, research must have potential broad population applications, rather than a narrow focus on a very specific issue or group. Where specific populations are proposed, applicants must be explicit about how the research and its applications are relevant to a broader population.

21. Specific characteristics that are of particular importance for policy include:

  • Health status and morbidity – particularly long term mental and physical health conditions, disabilities, presence of comorbidities and pain;
  • Protected characteristics as defined by the Equality Act 2010- particularly age, gender and ethnicity;
  • Aspects of socio-economic disadvantage such as area deprivation; and
  • Employment conditions and relations - including employment contracts (e.g. gig economy), size of workplace.

22. Applicants should consider the different ways in which these groups may be affected by the topics, issues or interventions being considered and any ways in which this could be explored in proposed research studies.

Systems, associated actors and stakeholder engagement

23. Health and work experiences, issues and outcomes all occur in a complex system with interactions between many different actors such as individuals, employers, occupational health providers, healthcare professionals and other service delivery professionals. Collaboration between these different actors is vital for achieving positive health and work outcomes. We are particularly interested in research that takes into consideration:

  • The needs and experiences of, and challenges faced by different actors;
  • Collaboration between different actors within or across settings (e.g. workplaces, healthcare, community); and
  • Factors that either facilitate or prevent actors from being able to take an active role in supporting people experiencing sickness or with health conditions or disabilities to return and remain in employment.

24. There is scope within this call for applicants to consider a variety of methods or data developments which could support working with different actors. Proposals should describe how different stakeholders could be engaged and how coproduction elements could be incorporated.

Health and work outcomes

25. While there are many potentially relevant outcomes that studies on health and work could investigate, from a policy perspective, there is particular interest in outcomes where the domains of health and work intersect. Outcomes may include, but are not limited to:

  • Productivity;
  • Sickness absence; and
  • Employment outcomes for people experiencing ill health or disability (e.g. entry into work, return to work, job retention, flow onto benefits)

26. A wider set of relevant employment, health and wellbeing outcomes is still of interest, but it is essential that applicants demonstrate a connection to key outcomes which include elements of both health and work.

27. Policymakers also have an interest in the relationship between health and employment outcomes and the role of intermediate variables (e.g. psychological factors such as self-efficacy, expectancies and beliefs) along with their role as potential mediators or moderators of outcomes; and we would welcome research studies that allow for exploration of these factors.

Areas that are out of scope

28. The following types of study are out of scope for this call:

  • Studies focussed on very specific issues or groups which would be difficult to apply to a broader population in a wide range of settings;
  • Studies focused solely on workplace safety or industrial injuries;
  • General health promotion or health behaviours research; and
  • Evaluations of current national government policies (such programmes contracted by the Department of Work & Pensions.), where separate plans may already be underway to fulfil any such requirements from a policy perspective.

Research priorities

29. The research priorities in this specification have been developed in collaboration with the Government’s Work and Health Unit – which brings together teams from the Department for Work and Pensions and Department of Health and Social Care – and in consultation with the wider research community. This included an open invitation to submit priority research questions ahead of a stakeholder workshop which NIHR hosted in October 2019. 

30. Given the complexity of health and work research and practice, the themes outlined below are not mutually exclusive. For example, the same actors, and shared aims, principles or actions may be relevant across multiple themes.

A. Understanding population needs in relation to health and employment among working age people

Rich descriptions of populations and their needs that can inform policy assumptions.

31. We need a good understanding of distributions and variations of characteristics, needs, experiences and outcomes among the working age population in relation to employment and health to allow us to effectively target and design policies and interventions. Our interests include:

  • Explicit knowledge about how health and work characteristics correspond with protected characteristics, aspects of socioeconomic position and other social circumstances; 
  • Distributions and drivers of psychological and cultural factors that affect health and work outcomes, including illness perceptions, health beliefs, workplace culture;
  • The relationship between morbidity and functional capability (for work and other activities) across the lifecourse, including any variations by cohort; 
  • Experiences of work for different cohorts and implications for future health and work needs and outcomes, including transitions into the labour market.

B. Supporting participation in good work for people experiencing sickness or who have long term health conditions or disabilities

Research that could lead to the improvement or development of activities aimed at supporting disabled people and those experiencing ill health that affects their ability to work, to remain in work, or re-enter work where that is beneficial for their health. 

32. Supporting people through periods of sickness at work, and preventing job loss associated with ill health or disability is the focus of several government initiatives, including proposals set out in the recent government consultation ‘Health is everyone’s business’. (DWP/DHSC. Health is Everyone’s Business: proposals to reduce ill-health related job loss; 2019). Action in this area will require the involvement of different actors including individuals, line managers, other representatives of employers, as well as occupational health providers and healthcare professionals, including GPs and Allied Health Professionals. 

33. We have a specific interest in research projects which address key issues around Occupational health (OH) and Vocational Rehabilitation (VR) as outlined in ‘Health is everyone’s business’.[11] This identified several issues in the commercial OH market, which currently delivers the majority of OH services. These include: lack of knowledge of OH, cost as a key barrier to purchasing OH and shortages in the OH workforce, particularly clinical staff, which risk the future capacity of the market to deliver services. There is potential for more rapid innovation particularly targeted at small/medium enterprises (SME) and self-employed people. The measures outlined in Health is Everyone’s Business form a strategy for reforming the OH market, both to increase demand for OH and address these issues.

34. We also have an interest in health promotion and employer/workplace interventions. i.e. what levers and approaches effectively motivate employers to institute health promoting interventions/conditions in workplaces? What are the barriers and enablers to creating and maintaining health-promoting workplaces?

35. The Government has commissioned trials and tests of promising models of support to help people with health conditions and disabilities to stay in and return to work which bring together these actors, including Randomised Control Trials (RCTs) of Individual Placement and Support (IPS) for people with common physical and mental health conditions, and those with alcohol or drug addiction; the JOBS II model of employment support to build jobseeker self-efficacy; and employment advice in IAPT services, with studies reporting by late 2021.

36. We are seeking studies that focus on new models or approaches, or further advancement of promising models. We are particularly interested in studies which focus on implementation issues. This may involve formative and summative evaluations, intervention studies or research that informs future intervention design and delivery (e.g. research that seeks to understand how best to encourage uptake of interventions, to promote relevant interactions and build capability amongst employers and/or healthcare professionals). We are interested in research that provides greater understanding of what and how interventions are delivered and provides insight into the most valuable components of an intervention.

37. Policy interests include:

  • Research that will advance effective interventions to support people to recover and/or cope with health conditions while continuing to work, where appropriate; 
  • Understanding factors that affect the sustainability of health and work outcomes and what helps to improve outcome sustainability; 
  • The content, timing and mode of brief interventions for return to work;
  • Research into systems-linking to ensure the right actions happen at the right time in the right place; and
  • Research that will inform promotion of ‘good work’, job enrichment and progression at work.

C. Trends, new developments and delivery models

That have implications for the design of health and work interventions or services, and/or health and work outcomes; new ways of approaching design and delivery of support.

38. A range of social, demographic, technological and economic developments may affect future health and work needs and the nature of appropriate and effective policy responses. Early research on emergent trends, including new forms of work, and the role of digital in facilitating work will inform longer-term policy formulation and shorter-term innovation.

39. Policy interests include:

  • Approaches to mitigating the risks of new forms or emergent trends in ways of working (e.g. gig economy, homeworking), including any implications of the COVID-19 pandemic. 
  • The role of technology as a barrier or enabler to health and work outcomes.
  • New approaches and settings for identifying and addressing health and work needs, such as health interventions in workplace settings.
  • Impact evaluations of publicly delivered OH or VR, multi-disciplinary OH/VR delivery models, innovative ways of providing OH/VR services to SMEs and any innovative technological solutions to providing cost-effective OH to SMEs and self-employed people.

Considerations for Research

38. Prospective applicants are encouraged to consider the following critical areas in developing their proposals, wherever relevant.

Policy Relevance

39. This call is funded by the NIHR Policy Research Programme (PRP) which commissions research to inform Ministers and senior policy makers. Researchers should demonstrate the relevance of their proposed research to evidence users, for example, how research could inform policy assumptions, the direction of Government strategy, formulation of policy measures, or broad population-based interventions or services.

40. In addition, the COVID-19 pandemic has highlighted the interrelationship between health and work and raised new questions, for example on health implications of different working patterns and work environments. We are not specifically inviting studies focused on experiences or challenges that have been raised by the COVID-19 pandemic, but applicants should consider how any relevant issues prompted by the pandemic might be explored in their study, particularly where there is clear relevance to government priorities around supporting workforce health and economic recovery.

Equality and health inequalities

41. There is a significant body of evidence that describes the scale and nature of health inequalities including those related to employment across the UK. We are interested in whether and how interventions support health equity and equality across groups. Applicants should demonstrate how their research can help support these aims.

Methods

42. A wide variety of approaches, methods and techniques can help provide policy relevant evidence including, but not limited to: secondary data analysis, data developments (including data linkage and modelling), economic analysis, qualitative research (stand alone or as part of mixed methods approaches), observational studies, psychometric studies, intervention studies (including RCTs) and evaluations (with theory based, impact and economic components).

43. Applicants must clearly demonstrate the suitability of their proposed methods for answering their research questions and producing policy relevant evidence. 

Interdisciplinary approaches

44. A range of disciplines, perspectives, approaches and methods have relevance for policy relevant health and work research. Some issues may benefit from studies that take a particular perspective but in many circumstances interdisciplinary approaches and multiple perspectives will be valuable throughout a study lifecycle. For example, this may involve combining clinical experts with social scientists, and expertise from both the health and employment domains. Applicants are therefore particularly encouraged to bring together interdisciplinary teams as appropriate for proposed studies.

Feasibility

45. Meaningful engagement of employers is a prerequisite for generating high quality evidence on interventions through the workplace. Similarly, research exploring how to address non clinical needs in health settings require meaningful, ongoing engagement with healthcare professionals to secure buy-in and strong co-operation.  Previous studies in this areas have faced considerable challenges securing the buy-in and co-operation of employers and healthcare professionals to enable appropriate referrals, data collection, and other activity required for research studies. 

46. A key consideration for proposed studies involving primary data collection is therefore how study recruitment and engagement will be approached. The funding committee will expect to see a thorough consideration of the feasibility of any research, especially where employer or healthcare worker engagement is fundamental to its success.

47. Other feasibility issues, including any implications of the current COVID-19 pandemic (e.g. on timing, research methods etc.) should also be explicitly covered in proposals.

Implementation Issues

48. Health and work interventions are complex social interventions, and may not work as intended when attempts are made to spread or to scale approaches that have shown positive results in pilots or trials. Evaluations that focus solely on average population effects may miss vital information about how different groups experience or are impacted by the intervention, and critical contextual factors for success in a particular area or setting. We need to strengthen our understanding of how health and work interventions can be successfully implemented, with what resources and in what context; including making better use of lessons learned across different studies of similar interventions. We also need to improve our understanding of the resource implications of different approaches to health and work support, engagement and recruitment issues, and the capacity and capability of different roles that play a part in delivering support (particularly in the NHS, occupational health sector and welfare system).

Knowledge translation and evidence-based practice

49. In addition, a strong evidence base in a particular area doesn’t always translate into successful practical tools, interventions and services that work on the ground. A key interest for policy makers is how they can best influence the behaviours of key actors that have a bearing on health and work outcomes (e.g. employers, healthcare professionals, occupational health providers) by translating evidence-based approaches to facilitate their adoption at scale. A range of evidence-based tools and guidance products already exist to inform practice, but there is less knowledge about their impact. Therefore, within this call we welcome studies that consider how to influence practitioners and employers to adopt evidence-based interventions.

Budget and duration

50. Funding will be available for at least two commissioning rounds and will be allocated flexibly across projects, across disciplines and settings on a broad range of themes. The next funding round is currently planned for May 2021.  NIHR is expecting to fund projects at a cost of between £250,000 and £750,000 per project although lower cost projects are also encouraged. However, there is no guarantee that studies from each of the priority areas will be funded. Funding to that level will only be available if there are suitable high quality and relevant studies. In all cases, projects are expected to last no longer than 36 months. However, where applicants believe further value could be obtained from extending the project beyond a three-year period, they are welcome to provide details for the panel to consider as long as this is accompanied by strong rationale. There are no guarantees that any such extension would be granted, and therefore applicants should ensure that their main proposal is still deliverable as a standalone project, within three years. Applicants are encouraged to read paragraphs 43 – 45 above about feasibility issues when considering timelines to propose for projects.

51. The duration of the research and individual projects within the contract will be no longer than is consistent with high quality studies. In assessing proposals, the Department will be seeking value for money as well as scientific excellence and, in particular, the potential for policy impact which is key.

52. Applicants are asked to address the timing and nature of deliverables, maximising staff resources and other options for interim reporting in their proposals.

53. 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 Committee members will assess applications against.

54. All applications are expected to start within 2 months of funding being agreed, subject to pre-contract negotiations and specific requirements.

Governance

55. The successful applicants for this research may be required to review their research objectives with an established research advisory group including representatives of relevant stakeholders and arm’s length bodies and to share emerging findings on an ongoing basis. 

56. You will be expected to:

  • provide regular feedback on progress
  • produce timely reports to the advisory group
  • produce a final report for sign off 

57. Key documents including reports must be provided to DHSC in draft form allowing sufficient time for review.

58. The NIHR may approach one of the successful applicants to act as a co-ordinator for the programme as a whole. For example, to set up an annual research presentation meeting in conjunction with DHSC and its partners. Please do not cost for this activity; an additional sum will be allocated for this during pre-contract negotiation.

References

  1. Office for National Statistics (2020) Labour Market Overview, UK. November 2020, Table A08.
  2. Department for Work and Pensions (2020). The employment of disabled people 2019
  3. Department for Work and Pensions/Department of Health and Social Care (2019) Health in the Workplace – Patterns of sickness absence, employer support and employment retention
  4. Marmot (2010) Fair society, healthy lives: the Marmot Review – strategic review of health inequalities in England post-2010
  5. Public Health England (2015) Local action on health inequalities: promoting good quality jobs.
  6. Hayday, Rick, Caroll, Jagger and Hillage (2008) Review of the Effectiveness and Cost Effectiveness of Interventions, Strategies, Programmes and Policies to Help Recipients of Incapacity Benefits Return to Employment (Paid and Unpaid)
  7. Waddell and Burton (2006) Is work good for your health and well-being? An independent review
  8. Black (2008) Working for a healthier tomorrow: work and health in Britain.
  9. Black & Frost (2011) Health at work – an independent review of sickness absence in Great Britain
  10. DWP/DHSC (2017) Improving lives: The future of work, health and disability
  11. DWP/DHSC (2019) Health is Everyone’s Business: proposals to reduce ill-health related job loss

Key documents

DWP/DHSC (2016) Work, health and disability Green Paper data pack