Timetable and Budget
| Description | Deadline/Limit |
|---|---|
| Deadline for Stage 1 Applications | 13 February 2024, 1 PM |
| Notification of outcome of Stage 1 Application | April 2024 |
| Deadline for Stage 2 application | 04 June 2024, 1 PM |
| Notification of outcome of Stage 2 Application | November 2024 |
| Expected Potential Project Start | January 2025 |
| Project Duration | Up to 36 Months |
| Budget | Up to £600-700K |
NB: be aware we previously ran this call in Round 37 (opened September 2023)
Introduction
We know that child health lays the foundations for adult health, and some health conditions and behaviours start in early life. Parental and family health and circumstances can also affect children’s health and wider life outcomes. Therefore, there is a clear case for intervention in infancy and childhood to improve outcomes across the lifecourse both on health and more widely.
The National Institute for Health and Care Research (NIHR) Policy Research Programme (PRP) invites applications for a single research project to create or utilise an existing model to identify and quantify the potential economic benefits of intervention in the early years. This will in turn enable us to make a stronger case for investment in the early years in future and will ensure HMT can make an informed decision on the appropriate level of investment and on which outcomes should be prioritised.
Background
Policy development in the early years
There is strong evidence that the critical 1,001 days from conception to the age of two have a significant impact on the health, wellbeing, and opportunities of babies and children throughout the rest of their lives. But there is a lack of evidence that quantifies these impacts as benefits are not often realised until later in life, therefore quantifying benefits needs to be done by looking retrospectively or using an experimental design where modelling is important. Investing in this critical period presents a real opportunity to improve outcomes and tackle health disparities by ensuring that babies and families have improved access to quality support and services.
Governments across the world have responded to this and are focusing on the opportunities that investing in this critical period can bring. There is wide parliamentary support for investing in this period in England, with an active All Party Parliamentary group (APPG) with the Parent Infant Foundation acting as secretariat.
The Start for Life Unit based in the Department of Health and Social Care works across Government and with the wider sector to implement the Government's Best Start for Life Vision and transform support for families during the 1,001 critical days. The Unit is delivering a £170m Start for Life package that was announced in the 2021 Spending Review.
Policy development in children and young people
For children of all ages, universal programmes are available, including mental health services, dental health services, safeguarding, immunisations programmes and physical activity guidance.
Spending on children’s 0-5 services via the Public Health Grant to Local Authorities was £0.9bn[1] in 23/24, consisting largely of health visitor teams that deliver the 5 universal home visits (part of Public Health spending). Children’s 0-5 services play a crucial role in improving outcomes and tackling health disparities, additionally playing a key part in the Prime Minister’s priority to support families.
Research priorities
We require research that estimates the lifetime benefits of improving specific outcomes for babies, children and young people. This will include identifying the named outcomes and undertaking modelling to estimate the potential economic benefits of improving these outcomes.
Research questions
- What is the long-term economic value of improving specific outcomes (e.g. health, education) for babies, children and young people? For example, if we improve outcome indicator “X” by “Y%” (or one standard deviation), what is the long-term economic value?
- What impact does improving early outcomes have on those babies as children, then adults? And what impact does improving outcomes for children have on their outcomes as adults?
- For each outcome indicator, what components make up this long-term economic impact (e.g. public costs such as NHS, social care, education, crime, tax and benefits and quantified health benefits such as QALYs)
- When in the lifecourse do these benefits occur? Note: this would improve our ability internally to undertake our own economic modelling and assess when break-even points of potential investments may be reached.
- Which outcomes have the potential to drive the biggest economic impacts based on the analysis?
- How sensitive are these findings to changes in long-term economic costs, e.g. does a small change in public costs lead to different outcomes driving the biggest economic impacts?
- In the case of early years (0-2 years) outcomes, how do these outcomes map onto or link to the SfL Outcomes Framework (currently in development)?
- If possible, do equivalent changes in outcomes lead to differing lifetime benefits for different groups?
- How does this vary by outcome indicator? Which outcome indicators see the largest variance in lifetime benefits across demographics?
- Which outcomes should be focused on from a disparities perspective as a result?
Note: This research will need to control for infant, family and neighbourhood/environmental characteristics when calculating how an improved outcome generates long-term economic value, to isolate the impact of each specific outcome in question.
Proposed research methodology
The research methodology will be guided by the researcher’s expertise, however, we envisage that this work would:
- Review existing modelling work that estimates the impact of outcomes over a lifetime in differing policy areas.
- Conduct a literature review to identify specific 0-2 years and childhood outcomes and any economic evidence on these outcomes is also a product we would be interested in.
- We expect the research team to develop or utilise an existing model to link the 0-2 and childhood outcomes to childhood/adolescent and adult outcomes.
- Analysis on how changes in each of these 0-2 and childhood outcomes results in changes to lifetime outcomes and lifetime benefits would be useful. Any commentary on which specific outcomes have the potential for large lifetime benefits is also of interest.
The table below is an example of outcomes that could be included in the model. The final outcomes that are included in the model are up to the researcher’s discretion, but in the case of 0-2 outcomes we would like these outcomes to be linked as closely as possible with the Start for Life Outcomes Framework which is still currently in development. The researcher will need to engage with DHSC to ensure that this is the case.
Example of outcomes in infancy, childhood and adolescence
| Outcomes (This is only an example) | - | - | - | - |
|---|---|---|---|---|
| Infancy | Early childhood | Late childhood | Adolescence | Adulthood |
|
Breastfeeding outcomes |
Cognition |
Cognition Emotional development Conduct problems Obesity Longstanding health condition Special educational needs Truancy Antisocial behaviour |
Cognition |
Mental health |
We are then interested in the long term economic impact of the outcome variables. As flagged previously, these long term economic impacts could take the form of Quality Adjusted Life Years, public health costs etc. The below table outlines examples of the economic impacts that could be considered at each life stage, but again the final costs/benefits that are chosen will be up to the researcher’s discretion.
Example of long-term costs in infancy, childhood/adolescence and adulthood
| Long term economic impacts (This is only an example) | - | - |
|---|---|---|
| Infancy | Childhood/Adolescence | Adulthood |
|
QALYs Public health costs |
QALYs Criminal justice system |
QALYs Criminal justice system |
We believe microsimulation modelling would be the appropriate approach to conducting this research. Examples of academic work that use methods similar to what we are looking for in this research project to estimate long term costs in different policy areas can be found in the references and key documents section[2][3][4][5][6]. The existing work we are aware of does not currently link to early years.
We would expect the model to be based on a range of data sources. This would include, but not be limited to, extended ECHILD - a new data share which will link a wide range of health and education data together which should be available in Spring 2024 [7].
Areas out of scope for this programme of work
This research is focused on England, areas within the UK but not in England are considered out of scope.
The research should focus on quantifying the lifetime benefits of improving outcomes of babies, children and young people, the return on investment of a specific intervention in the child health policy space is not in scope.
Eligibility
Eligibility for the NIHR PRP is laid out in our Standard Information for Applicants and applies to all calls unless otherwise stated in the individual research specification.
Expertise required
- Familiarity with the early years and child health landscape.
- Knowledge of the economic theory behind the case for intervention in the early years.
- Experience undertaking microsimulation modelling to quantify the long-term impact of changes in outcomes, ideally within a health context.
- Expertise in conducting literature reviews on economic research.
- Expertise in communicating complex economic models in a clear and accessible manner.
Outputs
An initial output will be a literature review that outlines existing research that uses microsimulation modelling to model the impact of improving outcomes over a lifetime in differing policy areas. The literature review would then separately identify specific, 0-2 and childhood outcomes and identify economic evidence for these outcomes.
The main outcome of the research will be a model that can be used to quantify the long term economic impact of improving specific target outcomes in both infancy and childhood. This model would be used by policy analysts in government. By changing the input parameters, the user will be able to explore which target outcomes are likely to offer the greatest return in terms of benefits at later stages of childhood, adolescence and adulthood. For example, the model could be used to explore the impact of increasing breastfeeding rates at 6 months on school readiness, hospital attendances for infections, obesity and cardiovascular disease, and in turn attach a monetary benefit for all of the adverse effects averted.
A final output will be a report with detailed analysis on how changes in each of these 0-2 and childhood outcomes results in changes to lifetime outcomes and how this translates to benefits/long-term economic value. The report should also provide comment on which specific outcomes have the potential for large returns on investment and should outline future work that could build on this 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
We would expect this project to be delivered within the period from January 2025 to January 2028.
This is a multi-year project, so neither final or interim findings will be ready for any Spending Review in 2024. However, this project will be valuable for future Spending Reviews regardless of timings.
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.
Management arrangements
Office for Health Improvement and Disparities (OHID) and DHSC more widely, 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 and model 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.
Guidance on Health and Care Inequalities and associate data collection within NIHR PRP Research:
Health and care 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 ask that you please clearly identify in the research plan section of the application whether your application has an inequalities component or theme as well as how this research hopes to impact inequalities or not. Please also detail the core set of inequality breakdown data that will be collected, if applicable. More information on this request can be found in the Standard information for applicants.
References and key documents
- [1] Finch D, Vriend M. Public health grant [Internet]. [cited 2023 Sept 7]. Available from: Public health grant.
- [2] Skarda I, Asaria M, Cookson R. Evaluating childhood policy impacts on Lifetime Health, wellbeing and inequality: Lifecourse distributional economic evaluation.
- [3] García JL, Heckman J, Leaf DE, Prados MJ. The life-cycle benefits of an influential early childhood program. 2016
- [4] Cattan S, Conti G, Farquharson C, Ginja R, Pecher M. The health effects of universal early childhood interventions: Evidence from sure start. 2022
- [5] Milton B, Whitehead M, Holland P, Hamilton V. The social and economic consequences of childhood asthma across the Lifecourse: A systematic review. Child: Care, Health and Development. 2004
- [6] MACMILLAN R. Adolescent victimization and income deficits in adulthood: Rethinking the costs of criminal violence from a life-course perspective*. Criminology. 2000;38(2)
- [7] 1. Ucl. Welcome to the Echild Project Website [Internet]. 2023 [cited 2023 Sept 7]. Available from: Welcome to the ECHILD project website | UCL Great Ormond Street Institute of Child Health [accessed September 2023]