The National Institute for Health and Care Research (NIHR) and the UK Research and Innovation Engineering and Physical Sciences Research Council (EPSRC) invites proposals from multi-disciplinary teams to take a systems design and engineering approach to improve services for people with multiple long-term conditions (MLTC) and their carers. This programme has a broad definition of MLTC, which includes people with complex care needs (definition in paragraph 8) and has been developed through two joint workshops held with the NIHR and EPSRC research communities and people living with MLTC. This will be a two stage call including seed funding to progress to a stage 2 application for an Innovation Hub.
A multi-disciplinary approach to research is vital for understanding how we can best configure health and care services around the needs of people with multiple long-term conditions (MLTC) and provide evidence to support sustainable and effective changes to UK service delivery and outcomes. The SEISMIC programme will support teams to develop innovative engineering and mathematical whole-system science approaches to understand how to improve the configuration of health and care services to better take a patient-centred, whole person approach to the treatment and care of people with MLTC. These Innovation Hubs should take collaborative research approach to fully capitalise on the expertise from the NIHR and EPSRC research communities.
While the evidence shows that older people are more likely to live with MLTC than younger populations, the burden of MLTC at all ages is significant, and younger people will be living with MLTC or complex care needs requiring treatment, care and support for longer. We welcome applications for research to address MLTC across the whole life-course, from birth to end of life. All research teams should address health inequalities within their programmes of work and consider how their research will meet the needs of people with MLTC in under-served regions and communities with major health and care needs.
The EPSRC works in partnership with others to deliver engineering and physical sciences research to transform the nation’s health and wellbeing. This includes tackling the most pressing health challenges including MLTC. Our research delivers tools, technology, novel analytical techniques and innovation needed to generate effective solutions that will deliver better quality of life and ensure higher standards of affordable health and care. The theme of MLTC has emerged as an important topic from a number of discussions with the EPSRC community including the currently underway strategy refresh.
Supporting MLTC research is a priority for NIHR and the NIHR has published a strategic framework for research into MLTC. This sets out high level aims for an evidence base; and a cultural change to facilitate high-quality research for patient benefit.
The commissioning for this large-scale programme takes a phased approach. Seed funding of up to £200k over 18 months per team is available to allow sufficient time and resource to enable groups to apply for a full-scale Innovation Hub. Applicants will be invited to apply for a Hub through a competitive process that will support for the strongest bids. We anticipate that within this development phase teams will:
- Build appropriate networks of stakeholders across the systems engineering, mathematical sciences, information and communication technologies research, and health and social care pathway.
- Embed patient and public representation from diverse groups of people with lived experience of MLTC and carers at the heart of their programmes to ensure research addresses what matter to people with MLTC and all outputs from the Hubs are user- centred.
- Develop and carry out novel underpinning engineering and mathematical sciences research to map patient journeys and pathways and better understand and articulate the factors and relationships that underpin the health and care systems for this heterogenous population.
- Conduct acceptability and feasibility testing for innovative services or pathways with a range of stakeholders, such as NHS England and Improvement and equivalent organisations.
At the end of the development phase, all groups will be expected to apply for a full-scale Innovation Hub. Funding is available for £3-6m per Hub over five years, depending on the scale and remit of the challenge that groups are seeking to address. The teams will be commissioned by the NIHR and EPSRC to develop:
- Innovative engineering and mathematical whole-system science approaches to understand how to improve the configuration of the health and care system and provision and delivery of services that take a patient-centred, whole person approach to the treatment and care of people with MLTC
- To develop and test pathways for new or modified services in health and care settings.
- To evaluate pathways which seem to have traction for people with lived experience of MLTC and service policy decision-makers.
- To bring in new ideas and approaches and to identify and propose tools, and new technologies to support a more integrated approach to health and care for people with MLTC.
All Hubs must have joint-PIs, one from the systems engineering and mathematical sciences community, and a second from the health and care research community. The NIHR and EPSRC are looking to support genuine partnerships that draw on the strengths and insights of both communities. All Hubs should have embedded public and patient involvement from diverse set of voices from inception to dissemination.
For the purposes of this document, the following definitions apply:
Multiple Long-Term Conditions: The co-existence of two or more long-term conditions, each one of which is either: a non-communicable physical or mental health condition of long duration, such as a cardiovascular disease, cancer, mood disorder or dementia; or an infectious disease of long duration, such as HIV or hepatitis C.
People with Complex Care Needs: People living with one ‘named’ condition which affects multiple systems within the body (e.g. Cerebral Palsy, Ehlers-Danlos Syndrome, Cystic Fibrosis). This includes people with rare diseases and children with congenital conditions. This population’s experience of the health and social care system is similar to people living with MLTC, bringing them, and their families, into contact with a range of services led and managed by different parts of the system (health, social care, education).
Systems Engineering Approach: A systems approach can be defined and applied in a health and care context as a series of questions that integrate people, systems, design and risk perspectives in an ordered and well executed manner.
Multiple Long-term Conditions
A substantial and growing number of people around the world suffer from two or more long-term conditions (MLTC). According to the Chief Medical Officer’s Annual Report (2018), having MLTC affects quality of life, leads to poorer health outcomes and experiences of care, and accounts for disproportionate healthcare workload and costs. As the Covid-19 pandemic has progressed, MLTC have been suggested as indicators of severe adverse outcomes, further bringing into relief the need to design health and care systems around people with MLTC and carers and to begin to tackle these longstanding issues.
It is estimated that more than 14 million people in England are living with MLTC and that they account for over half of NHS primary and secondary care costs. MLTC are particularly prevalent in older people with a large study from Scotland reporting that nearly 65% of those aged 65-84 years were identified as having MLTC, increasing to 82% of those over 85 years. However, MLTC affects people across the life-course and in absolute numbers, the majority of people living with MLTC are under the age of 65. Children with congenital conditions and people living with rare diseases can have multi-system problems which accumulate in much the same way as multiple long-term conditions, hence their inclusion in this programme of research. Young people often have a combination of physical and mental illnesses, with the interaction between the two making treatment more complex. In addition, certain periods of life, such as pregnancy, increases the probability that multiple conditions will present simultaneously, and services need to better take account of these issues.
Research shows that socioeconomic deprivation is strongly related to the acquisition of MLTC, appearing some 10-15 years earlier in people living in the most deprived areas compared with the most affluent areas. The Richmond Group of Charities most recent report highlighted the ways in which the system could enhance support for people subject to health disparities to prevent and manage a life with MLTC.
Research has also shown a geographical divide in age-standardised prevalence of MLTC, with the highest levels in Yorkshire and Humber and the North East regions of England, and the lowest levels in London. The case fatality rates for people living with MLTC was highest in the North West, Yorkshire and Humber and the North East.
A Systems Engineering Approach
In 2017, the Royal Academy of Engineering, Academy of Medical Sciences, Royal College of Physicians and Future Hospital came together to provide a definition of the systems engineering approach as applied to the health and care system; and a framework to support transformation and improvement in this complex system. According to this report, a systems approach for health and care considers all relevant elements of a complex system – people, design, systems and risk - and the nature and performance of the interfaces between them to drive transformation. To successfully change systems and services, all aspects of the system must be considered, including the needs of patients, carers, and healthcare professionals, and the alignment of technology, processes and policy to deliver innovative solutions. In a systems engineering approach iteration is key – a systems engineering approach changes the system until it works, or until it’s clear that no further improvement is possible.
They propose three key questions to systematically and iteratively guide a system to become more effective:
- What is the problem? – leads to a common and clearly articulated view of a better system based on an understanding of the current systems (problem).
- Who should be involved? – leads to a common and clearly articulated understanding of who should deliver the improved system (team).
- What does ‘good’ look like? – leads to a common and clearly articulated understanding of success and how it would be measured (success).
The EPSRC and NIHR held two joint events in January and February 2021 to bring together the engineering, operational research, and health and social care research communities to develop an understanding of how taking a systems approach to MLTC research could benefit this growing population of people. These events built on a series of workshops that NIHR commissioned in 2019 to understand what matters most to people with MLTC and carers, including children and young people, those of a working age and older people. Across the range of workshops, patients and carers challenged the system to move away from poorly coordinated care designed around single conditions; inadequate communication; imperfect integration of mental and physical wellbeing; and consultations that focus on clinical outcomes rather than patient-oriented goals; all of which led to treatment burden and affected their quality of life. People with MLTC would like to see a health and care system that is designed to work for people like them.
The first EPSRC-NIHR workshop focused on identifying the research opportunities to inform the design and delivery of health and social care services for people with MLTC. Attendees identified the following priority topics where taking a systems approach to MLTC research could lead to transformation towards the vision set out by people with MLTC and carers:
- High quality care should not be a task for the patient (How do we reduce the burden of accessing the right health and care? How do we configure a system that facilitates joined-up, personalised care?).
- People with MLTC have diverse needs, and a person’s needs will change over time (how do we design a system that is responsive to the changing needs of a person with MLTC?).
- We need a cultural shift to get the system to re-orientate around patient needs (How do we create the right incentives to drive the system change we need to see?).
- Services need to be coordinated – both from patient perspective and in closer working between parts of the system (how do we improve navigation of the health system – e.g. care coordinators? How we improve and facilitate working across different disciplines/specialisms/parts of the system? How do we encourage the system to move away from siloed working and bring different specialisms (and care pathways) together? How do we incentivise the system to collect and use information and data in a connected and interoperable way?).
- Care needs to be driven by a better picture of patient’s health and needs/preferred outcomes over time (how do we collect, use, and share the right information at the right time? How do we ensure health and care remains responsive to changing patient needs?).
- Patients need to be empowered and supported, where they wish, to be active agents in health and care decisions.
Workforce education, opportunities and challenges presented by digital and technology, and health inequalities were all flagged as cross-cutting themes. Workshop participants reflected that the delivery of health and care, and research informing it, needs to work to reduce health inequalities, ensuring changes in service design or delivery works for the range of people with MLTC, including underserved communities.
The second EPSRC-NIHR workshop considered how we need to be innovative when thinking how to carry out programmes of research using systems engineering to configure health and social care services around the needs of people with MLTC.
This call will fund research that develops new and innovative systems design and engineering approaches to improve the configuration and delivery of services within the health and care system for people with MLTC and their carers. To achieve the aims of this call, successful Innovation Hubs will need to combine conceptual and methodological skills in systems engineering, mathematical and data science with clinical and health and care services research expertise, as well as the understanding and skills of people with lived experience.
We are seeking applications from multi-disciplinary and cross-institutional teams from across the UK. We will fund collaborations of researchers working in health and social care, engineering and mathematical sciences with other stakeholders within healthcare, such as health and care practitioners, educators, implementation scientists, commissioners, systems leaders, community organisations and people with MLTC and carers. Applications must include co-production with people with lived experience of the challenges set out above. Applications can come from syndicates or cross- organisational partnership.
We are looking to fund research that develops innovative engineering and mathematical science systems engineering approaches to understand how to deliver health and care services and systems that take a patient-centred, whole person approach to the treatment and care of people with MLTC.
Example research topics in scope could include but is not limited to development and evaluation of:
- Facilitating coordinated care between the health and social care systems. E.g. One-stop clinics.
- Coordination of services across health, education and social care for children and young people with complex care needs, and their families. This might include consideration of evolving needs as the children and young people grow older, including transition of care between children to adult’s services.
- New approaches to shared decision making. Using technology to bring information and data together in an interoperable way to support shared decision making between people with MLTC and their multidisciplinary teams.
- Improved training and tools to enable clinicians and allied health and social care professionals to deliver the care needed to ensure new models of personalised care for people with MLTC are successful.
- Bringing together physical and mental health services to prevent or ameliorate mental health problems.
- Providing care at the most convenient locations and times for people with MLTC and their carers, including in social care and other community or civic settings– facilitated by technology, new models of care and/or workforce utilisation.
- Improving the effectiveness/efficiency of the system for the diagnosis, treatment, and ongoing management for people with MLTC or complex care needs.
The list above is illustrative of the issues and problems raised by participants in our workshops and in the workshops NIHR held about what matters to people with MLTC and carers; they are also commonplace in the research literature. Research Collaborations should consider the needs of their local populations to develop a programme of work to tackle the challenges that matter to people with MLTC in their areas.
Applicants should consider the populations likely to be living with greatest burden from MLTC and seek to meet the needs of groups or regions with the highest health need. Burden on the individual, whether caused by the conditions themselves, the health and social care system response, treatment or polypharmacy, or the wider socio-economic context is key. As set out in ‘Better Research for Better Care’, people in regions and communities where the burden of need is greatest are often under-served by research.
A Phased Approach
We understand that to fund research which brings the NIHR and EPSRC communities together, there will need to be a phased approach to allow for sufficient time and resource to create multidisciplinary teams; develop in-depth understanding of the system where change is sought; understand the issues and outcomes that are important to people living with MLTC and their carers; develop appropriate methodology and outcome measures; and to develop a pathway to implementation and impact for patient benefit.
This programme will comprise of two funding stages, with networking and engagement events to support the development of applications. Please refer to the timeline section.
Seed funding of up to £200k is available for up to 18 months per team to undertake preparatory work to develop a full-scale programme of research. Applications should clearly describe how this development award will inform the programme for a future Innovation Hub.
A systems design and engineering approach requires people, systems, design and risk perspectives to be viewed collectively so it is anticipated that the development phase will focus on:
- Understanding what matters to people with MLTC and carers and the challenges they face within their local health and social care systems.
- Building multidisciplinary networks and bringing together researchers from the systems engineering and health and care community together in addition to a range of other research perspectives and expertise. Developing a shared vision, understanding and language to create a programme of work for an Innovation Hub.
- Ensuring buy-in from the health and care system, including primary, community, acute care and social care stakeholders.
- Understanding how potentially divergent views from stakeholder groups could be brought together to reach a consensus view which could lead to improvements in the efficiency and effectiveness of services.
- Underpinning work on systems mapping to understand how the system currently delivers services and care for people with MLTC and the interdependencies within the different parts of the system; this could include identifying where there would be potential for intervention to move to a system which balances clinical needs with goal-oriented, person-centred objectives.
- Identification of risks to understand the likelihood and potential impact of challenges and opportunities in the system.
- Scope modelling scenarios to map patient journeys and pathways to consider solutions ahead of real-world iterative implementation.
- Learning from the way in which the health and care system responded to changes required as a result of the SARS-CoV-2 pandemic could be included. Other case studies of good practice might be built up where they show a system which works well for people with MLTC.
- Work with collaborators, people with MTLC and wider stakeholders to consider where methodological innovations are needed and to develop outcomes measures which matter to people with MLTC to determine success.
All successful development award holders will be expected to apply for an Innovation Hub. A total of £3-6m is available for Innovation Hub delivered over a period of up to 55 months. Innovation Hubs are expected to move from an ‘understanding’ phase to a design and delivery phase through an iterative process, which seeks to test solutions until they result in improvements for people with MLTC and carers.
Applicants should note that we are looking for Innovation Hubs to do something truly transformative. Teams who submit proposals which are considered as business as usual for the programmes (e.g. NIHR Health Services and Delivery Research programme, EPSRC standard research grants) will be asked to submit via this route and will not be funded through this joint programme of work.
The lead organisation applying to this programme of funding must be either: (a) an NHS organisation (including NHS Trusts and NHS Foundation Trusts) or equivalent UK authorities, or (b) a university, research institute or not-for-profit organisation. In addition to these lead organisations, small and medium enterprises (SME) are also eligible to receive funding. If an appropriate case is made, then overseas university partners are permissible and may receive funding. We would expect the application to make a strong case that the chosen overseas academic partner was the organisation best placed to provide input to the planned research.
Specialist services or expertise may be brought into the team through consultancy or sub-contract arrangements with appropriate justification provided. Sub-contractors may be based outside of the UK. The day-to-day running of the Innovation Hubs should be through a dedicated project manager.
Large companies may be involved but are ineligible for funding. For all collaborations where a partner is providing in-kind contributions, the exact nature of the commitment of each partner must be clearly detailed and a letter of support supplied. Further detail on NIHR funding for industry can be found on the website.
If the application is successful, a standard DHSC contract will be let with the lead organisation for delivery of the research. There will be a Memorandum of Understanding with the EPSRC which will set out reporting and funder oversight ways of working.
The assessment criteria for this programme can be found below. The criteria for success for the full-scale Innovation Hub stage is subject to change based on learning from the development phase.
Patients and Public Involvement
The NIHR requires the active involvement of patients and the public (e.g. service users and carers) in the research that it supports. Applicants should describe how PPI will be embedded at the heart of their research programmes from inception to dissemination, how PPI has influenced the development of their application and at all levels of governance.
Applicants are required to detail what PPI is planned, how it will benefit the research and the rationale for their approach. They should set out how they are ensuring that a diverse and broad range of representation will be achieved in their programmes of work. PPI needs to be undertaken in a manner that acknowledges that some people may need additional support, or to acquire new knowledge or skills to enable them to become involved effectively (see INVOLVE publications for guides for researchers). Applicants should therefore provide information on arrangements for training and support. All PPI activities should be appropriately costed to enable meaningful participation.
More information and guidance is available in our PPI resources for applicants.
- Publish draft specification – July 2022
- Introduction webinar (feedback from research communities/ Q&A) - July 2022
- Publish final specification and development phase launch call – September 2022
- Networking events (opportunity for elevator pitches and team formation) – October & December 2022
- Close call (stage 1/EOI) – February 2023
- Funding Committee meeting with interviews – May 2023
- Development phase begins – July-September 2023
- Hub full application close – February 2025
- Funding Committee meeting with interviews – May 2025
- Hubs contracts begin – June/July 2025
Budget and duration
We expect to fund up to eight teams through the development phase and up to five Innovation Hubs. The range for the Innovation Hub award is up to £3-6m for up to 60 months. We encourage applications of varying scale, duration and objectives as suits the research aims of systems innovation hub and their research programme. We would like to see applications across the breadth of the UK, considering where the burden of need is for people with MLTC. The funding requested needs to be proportionate to the research aims and questions of the work programme. We will only allow one application from each host organisation. The same institution may be named as a collaborator on other applications.
Costing can include up to 80% full economic costing (FEC) but should exclude VAT. Applicants are advised that value for money is one of the key criteria used by peer reviewers and funding committee members to assess applications.
Applicants should be able demonstrate that they will be able to start their development phase by September 2023.
An independent research advisory group including representatives from a range of stakeholder groups,including the NIHR and EPSRC, should be established for each Innovation Hub. The advisory group will provide guidance to the project, meeting at least annually over the lifetime of the research. This group should have at least 50% independent membership and an independent chair and include PPIE. 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, and
- produce a final report for sign-off.
The funding panel will assess whether the teams applying have the potential to construct and lead a multidisciplinary team with the relevant expertise, partnership working capabilities and vision to apply for a full-scale Innovation Hub within 18 months.
All NIHR research should is required to contribute to reducing health inequalities, and this will be a success criterion for the Innovation Hubs applications. The development phase application should be mindful of this and outline how the development work undertaken during this phase will contribute to this.
Measures for success at the development phase
Relevance and fit to call
- demonstrate an understanding of the requirements of the ‘insert name of programme’ and the strategic objectives of the call
- offer a vision for an ambitious programme of work which focusses on what matters to people living with MLTC and their carers and has the potential to be transformative for patient benefit
- evidence a clear vision for how the proposed work in the development phase could lead to a full-scale Innovation Hub which can transform health and care services for people with MLTC and carers
Patient and Public Involvement and Engagement
- have a track record of, or a clear plan to, embed patient and public involvement in the proposed programme from inception to dissemination so that the research addresses the questions that matter most to people with lived experience of MLTC.
- demonstrate how PPIE has informed or shaped the development phase application
Strength of multidisciplinary team
- have a track record, or can demonstrate their credibility, in both health and care service relevant research, and in systems design and engineering-related methodologies and application to complex systems
- have access to a network of experts across the range of disciplines required to deliver a programme of work to respond to the requirements set out in the specification, or convincing plans
- to build this network over the lifetime of the development phase
- set out clearly how they are considering equality, diversity and inclusion in the development of the research team and PPIE groups.
Leadership and Management
- Co-PIs to be suitably qualified and experienced to lead the development of a multi-disciplinary team to ensure the research achieves a result greater than the sum of its parts
- set out appropriate governance structures to ensure delivery of the development phase and the production of a full Hub application
- set out the key risks to delivery (e.g. ethical, methodological, organisational) with associated mitigations
- outline a clear set of management arrangements which are suitably resourced and feasible within the timeframe of the development phase.
Strength of stakeholder plans for stakeholder engagement and relationships
- have experience of engaging and influencing a broad range of stakeholders across the health and care system to ensure the feasibility of a proposed programme of work to transform services for people with MLTC and carers over time.
- set out how it would involve stakeholders from their evolving Integrated Care Systems, including primary and acute care, community services and social care to understand the system and ensure buy-in to ensure the feasibility and application of proposed research for their Innovation Hub proposal. Applications that don’t look to integrate systems across health and social care (and education for proposals which look at children with complex care needs) will be considered less competitive at the Innovation Hub stage.
Quality of the research design and work plan proposed
- sets out an ambitious, clear and convincing programme of transformative work which responds to the requirements set out in the specification
- demonstrate an awareness and understanding of previous relevant research or developments in this area
- set out a well-defined methodology to achieve the underpinning research required to apply for a full-scale Innovation Hub in-line with the requirements set out in the specification
- creates novel and transformative research in Engineering and Physical Sciences, with associated application in the health and care systems.
- propose a coherent set of work packages that are fully justified and aligned with the overall vision of the proposal
Value for money
- demonstrate value for money, with full justification for the resources sought in the development phase
- a well-defined plan and budget for PPIE from a diverse range of voices from people with lived experience of MLTC. Training and support measures for PPI representatives should be described.
Measures for success at the full Innovation Hubs stage
- Relevance of the proposal in relation to the research specification
- Extent to which the proposal adds distinct value and advances existing knowledge and understand
- Responds to the call focus on what matters to people with lived experience of MLTC and their carers
Quality of the research design
- Suitability of the proposed methodology and the appropriateness of the approach to achieving impact
- Shows significant originality and innovation and has ambition and transformative potential
- Articulates a clear and feasible pathway to improve services for people with MLTC
- Complements other UK research funded in the area, including, but not limited to, existing investments through NIHR or EPSRC
Strength of multidisciplinary team and leadership
- appropriateness of the track record of the applicants and the research team to provide the breadth and depth of expertise necessary to the delivery of the proposed work
- expertise and experience of the Principal Investigators
- convincing and coherent leadership and management arrangements
- balance of skills of the project team, including collaborators, clearly stipulating the roles and responsibilities of each team member
- clear evidence that equality, diversity and inclusion is embedded across both the Innovation Hub team and stakeholders
Quality of the work plan and proposed management arrangements, including the ability to deliver the proposed project
- a coherent set of work packages, fully justified and aligned with the overall vision of the proposal
- appropriate work plan with clear milestones
- identification and mitigations are in place for key risks to delivery
- clear buy-in from delivery partners in the health, social care and wider systems as necessary for the successful delivery of transformative change through the research
- proposals for how the funded Innovation Hubs could work together to build capacity and capability among early and mid-career researchers
Resources and management including the effectiveness of the proposed planning and management and whether the requested resources are appropriate and have been fully justified
- sufficient description on the resources required to deliver the proposed work in a way that demonstrates value for money
- explanation as to whether time committed by applicants is realistic to ensure delivery
- a clear and credible description of dissemination and stakeholder engagement plans, including a description on whether identified audiences are appropriate and needs properly considered
- fully resourced and diverse patient and public engagement and involvement in the development of the application and throughout the lifetime of the project, with adequate and well justified training and support measures, and budget
- any equipment requested, or the viability of the arrangements described to access equipment needed for this project, and particularly on any university or third-party contribution
- any resources requested for activities to either increase impact, for public involvement or to support responsible innovation