Notes for Applicants

Transcription

1 Notes for Applicants Efficiency Research Programme A Health Foundation call for innovative research on system efficiency and sustainability in health and social care 15 April 2016 The Health Foundation Tel NOTE: All applications to the Efficiency Research Programme have to be submitted through our new online application portal AIMS.health.org.uk. We advise all potential applicants to familiarise themselves as early as possible with the application process. The process is outlined in section four of this FAQ document as well as in the AIMS user manual. 1/12

2 Contents About the Health Foundation 3 About our open call grant programmes 3 Aims and objectives 4 The current context 5 Our priority areas 7 Selection criteria and eligibility 9 Audience and dissemination approach 10 The budget 11 Key dates 12 2/12

3 About the Health Foundation The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. Our aim is a healthier population, supported by high quality health care that can be equitably accessed. We learn what works to make people s lives healthier and improve the health care system. From giving grants to those working at the front line to carrying out research and policy analysis, we shine a light on how to make successful change happen. We make links between the knowledge we gain from working with those delivering health and health care and our research and analysis. Our aspiration is to create a virtuous circle, using what we know works on the ground to inform effective policymaking and vice versa. We believe good health and health care are key to a flourishing society. Through sharing what we learn, collaborating with others and building people s skills and knowledge, we aim to make a difference and contribute to a healthier population. Further details about the organisation can be found at About our open call grant programmes Our grants support leading research teams to produce knowledge and evidence on what works to improve the quality, accessibility and the organisation of health and care services. The Health Foundation s 1.5 million Efficiency Research Programme is a researcher-led open call for innovative proposals for research into system efficiency and sustainability in health and social care focusing on four priority areas: allocative efficiency aligning incentives optimising the role of technology and the workforce optimising the spread and diffusion of efficient practice and innovation We are looking to support research programmes that are comprised substantially of quantitative research but welcome ideas that have elements of mixed methods. In this call we are also committed to encouraging fresh thinking into system efficiency and sustainability in the non-acute sector and as such we will be looking to support at least one research programme that has a focus on mental health and / or out of hospital care. In 2014 the Health Foundation made four long-term research grants via our Efficiency Research Programme and more recently, we made five research grants that will explore how behavioural insights can contribute to improving efficiency and reducing waste in health care. 3/12

4 Aims and objectives The Institute of Medicine s (IOM, 2001) analytical framework for assessing the quality of a health care system identifies six domains of quality. These are: safe: avoiding harm to patients from the care that is intended to help them. effective: providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and misuse, respectively). patient-centred: providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions. timely: reducing waits and sometimes harmful delays for both those who receive and those who give care. efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy. equitable: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status. Existing measures address some domains more extensively than others. The vast majority of measures address effectiveness and safety, a smaller number examine timeliness and patient-centeredness, and very few assess the efficiency or equity of care (IOM, 2005). Efficiency and ensuring that health and social care improvement is enacted in as efficient a manner as possible is a critical component for ensuring a high quality and sustainable health and social care system. New knowledge and evidence generation into how we can better understand efficiency and its interplay with other domains of quality is critical in the mission to advance the rigor of efficiency measurement and drive system improvements for health and social care, both now and in decades to come. The Efficiency Research Programme is the Health Foundation s research programme designed specifically to support ground-breaking research, over a three to five year timeframe. Projects will look into issues of efficiency and sustainability that have the potential to make a transformational difference to health and social care provision in the UK. Our intention is for this programme of research to complement, rather than to duplicate, the investments of other funders in this area. The aim of the programme is to generate new knowledge that provides an increased understanding of the impact of health care policy and process changes on costs, capacity, quality and productivity, and to increase the practical understanding of how to better implement, spread and scale-up value generating programmes in the UK. The programme complements the investments of other funders in this area and is also focused on areas of interest that complement and underpin the work of the Foundation s inhouse teams. 4/12

5 A key strength of Health Foundation activity in the area of efficiency is our history, commitment and strong reputation in the field of quality and quality improvement. Our aim is to focus our investments through this new research programme in a way that remains firmly rooted in the principle of quality improvement. Our aim is to identify and support innovative research that has the potential to make the greatest impact on the ground. In some instances this will involve high-risk, high-reward research programmes, which this call encourages. We are looking to support research programmes that are comprised substantially of quantitative research and welcome ideas that have elements of mixed methods. Additionally, we are keen to encourage ideas on system efficiency and sustainability in the non-acute sector (eg primary, community, mental health etc.) and as such we will be looking to support at least one research programme in this under-researched area. We wish to work with multi-disciplinary teams that include expertise in health economics, business and management, and operational research to explore some of the most powerful ways that health and social care services can address the challenge of increasing value and providing more for less. The research supported through this programme will be intended to provide powerful lessons and blueprints for change, which we hope will have a profound impact on thinking, planning and implementing transformative change that leads to the longterm sustainability of health and social care services in the UK. The current context More people are living longer lives, and increasing numbers are managing multiple health conditions. The range of available treatments grows ever larger, as does the range of health and social care services that people may need to interact with. Since 2010 the NHS has delivered some 18 billion of headline savings through the Quality, Innovation, Productivity and Prevention (QIPP) programme. Despite this, however, it is widely recognised that many of the most successful policy levers, such as freezing pay and bearing down on the tariff, are not sustainable over the longer term. Quite rightly, there continues to be pressure to ensure that any actions designed to bring the health and social care system onto a trajectory for long-term stability and sustainability also do not compromise care quality. The need for research into efficiency and sustainability of our health and social care services, thus, continues to be a concern of national importance as both health and social care services continue to work through a long period of constrained funding and uncertainty. Since launching our Efficiency Research Programme in 2014 the fiscal situation facing health and social care in the UK has been even more acute. Latest projections (Filling the Gap, the Health Foundation, November 2015) show that with NHS productivity growth at the long-run UK wide rate of 1% a year, by 2030/31 a funding gap of 23bn will emerge for the NHS, and 12bn for adult social care. 5/12

6 Policy responses have also increased over time with not just the Five year forward view, but also the Carter review, the Vanguards, CQC being asked to look at use of resources, and Lord Prior being appointed Minister for NHS Productivity. Health and social care services need to transform the way they work to cope with the challenges that they face. It is also increasingly clear, however, that a key part of the solution lies in the opportunities presented through fresh long-term thinking into issues of system efficiency and sustainability, rooted in the principles of quality improvement which span health and social care boundaries. A scan of the research landscape shows that there have not been fundamental changes in the last two years in terms of the funders and funding of system efficiency research. The largest funding streams of health policy efficiency research remain the same: the National Institute of Health Research, in particular the Department of Health s Policy Research Programme; and the arm's-length bodies. But the financial picture has meant that funding available for long-term, ambitious, research has dried up, and where funding is available it is more likely to be short-term and focused towards immediate solutions. Understandably, much of the existing focus is on more immediate solutions and fixes designed to ensure the short-term stability of the health and social care system. Our scoping suggests a number of research priorities that are needed to ensure that better decisions can be made for the long-term sustainability of the health and social care system, these include: updated evidence on large scale (re)configuration issues such as scale, scope and competition broadening research programmes in ways that recognise the sustainability of the NHS is tied to other public services such as community care, schooling, family support etc beginning to fill evidence gaps in under-researched, high-spend areas such as mental and community health that are presently black boxes in terms of robust information on efficiency and / or productivity more evidence on new models of care, in particular how new models relate to workforce, skill-mix, technology, and the types of payment and incentives needed to drive efficient behaviour variation and the drivers of variation in high-spend areas such as prescribing and older peoples care, and evidence on how best to diffuse and spread efficient and innovative practice across the health and social care system. In addition, there are underutilised methodological approaches eg micro-simulation modelling and data linkage beyond focus on Hospital Episodes Statistics (HES), as well as under-researched black-holes in system efficiency and sustainability eg the non-acute sector, that if addressed may offer a more nuanced understanding on how to go about addressing concerns of system efficiency and sustainability. Lastly, there is also potential for 6/12

7 generating new knowledge through mixed method analysis and innovative deep dive case studies. Our priority areas We have identified four priority areas for this grant programme within the broad themes of system efficiency and value for money in health and social care services. Our four priority areas are: allocative efficiency: achieving a more cost-effective mix of services within health and social care to maximise the health of the UK This theme incorporates ideas that develop a better understanding of how best to allocate funding at a macro-level to bring about greater efficiency without compromising care quality. aligning incentives to improve system efficiency and sustainability This theme focuses on how payment, financing and other incentive systems can be designed and implemented so as to generate greater efficiency and quality in ways that reinforce one another, span pathways, and do not trade-off short-term gains with unintended long-term inefficiencies. optimising the role of technology and the workforce to improve efficiency This theme explores how economic thinking can bring a fresh perspective to better understanding how changes in roles and use of technology can promote greater efficiency and value for money. optimising the spread and diffusion of efficient practice and innovation in health and social care This theme looks to better understand how to spread and diffuse efficient and innovative practice and to better understand what is having a positive influence on efficient behaviour at different levels of the health and social care system. These four themes are interlinked, and we recognise and would encourage that many research proposals will address more than one area. Applicants will be asked as part of the application process to identify and address which one of these themes their research will be predominately addressing. In addition, we will be looking to support at least one research idea in the underresearched area of system efficiency and sustainability within the non-acute sector i.e. primary, community, or mental health. Further information on each of the four priority areas is set out in the table overleaf. 7/12

8 Allocative efficiency: achieving a more cost-effective mix of services within health and social care services to maximise the health of the UK Aligning incentives: generating the greatest pull to improve efficiency and sustainability Technology and workforce: optimising the role of technology and the workforce to improve efficiency We are interested in research ideas that develop a better understanding of how allocative efficiency can be optimised including issues such as integration of care, reconfiguration of services etc. A research programme of interest to us may include a fresh look at sustainable models of health and social care based on up-to-date evidence, development of new measures of efficiency in currently under-researched nonacute areas such as primary care, mental health or community health, or research that adopts a health economy wide perspective of efficiency. Payment, financing systems and other incentive structures are crucial in shaping a health and social care system. We are interested in research ideas that aim to improve our understanding of how payment and financing systems alongside other innovative incentive structures can be designed and implemented in ways that reinforce one another, that can span full care pathways that cross traditional boundaries, and do not trade-off short-term efficiency gains with unintended long-term inefficiencies. This theme may consist of both qualitative and quantitative research that begins to look differently at the health and care system, perhaps starting with first principles, to explore what a good functioning market would look like and then identify the payments, financing arrangements and incentive structures, which in alignment can create the greatest pull to promote efficiency. Research in this area may explore issues such as how best to pay for a unit of health and social care, health economy wide payments systems, and configurations of incentives, perhaps drawn from behavioural insights, that encourage both high quality care and cost containment. As with payment and financing systems the configuration of the health and social care workforce and its interface with technology is a critical component of being able to make the types of savings and large scale transformation that can put health and social care on to a more sustainable path. Within this theme we are interested in ideas where economic thinking has potential to add a fresh perspective including the exploration of new models of care and changes in roles that promote workforce productivity, new 8/12

9 knowledge on how to roster staff better combined with more intelligent use of agency staff to bring about greater efficiency and value for money, and the identification and testing of specific strategies and incentives that can increase the productivity of defines part of the NHS and social care workforce. Again, we would be keen to see research ideas that span traditional boundaries of health within hospital and in mental health, community and primary care and social care with a focus on the patient pathways and local health economies. Diffusion of efficient practice: optimising the spread and diffusion of efficient practice and innovation in health and social care services There is a wealth of evidence, resources, tools and support geared around efficient practice and delivering value for money across the health and social care arena. There is also much evidence on the spread of innovation in other sectors, along with health and social care. Before more resources are created to encourage spread and diffusion of innovation and efficient practice, however, there is an urgent need to understand what is having a positive influence on efficient behaviour at the meso level. There is also a need to know more about why innovation that can bring about more efficient practice does not get adopted in the service. Research topics could include the development of a better understanding of what (optimally) to do when local variations are identified, pinpointing which resources are of most value to decision makers responsible for promoting efficiency within their service, identifying what more is needed and how such a resource can be co-created with the end-user, a better understanding of the critical factors for diffusion of innovation, and how to stop / restrict and / or decommission inefficient practice. Selection criteria and eligibility Applications for grants are expected to be programmatic and interdisciplinary, including multiple conceptually linked areas of work and a range of methodologies. Research projects should be based on an analysis of gaps in current knowledge in the field, especially gaps of importance to system leaders. We are interested in supporting innovative and ambitious research with the potential to support transformational change in health and social care services. We will favour projects that can demonstrate strong collaborative approaches including those with health and social care service partners in the design and delivery of the research. 9/12

10 Proposals will be assessed against the following key criteria: strength of case that the research will lead to improvements in quality whilst increasing efficiency and contributing to cost containment in health and social care provision large impact on patients and taxpayers usefulness and generalisability of anticipated findings across services, settings and systems practicality of and innovative application of robust and appropriate methodology appropriate project management approach, including risk management and quality assurance value for money relevant experience and expertise of the research team, and strength of partnerships/collaborations. The focus of this research programme is on funding original research that can contribute to health service transformation. Audience and dissemination approach The audience for this research is broad, and includes system leaders, policy makers, clinicians, managers, and researchers. We expect research funded through this programme to be widely disseminated, especially through leading peer review journals and conferences. We would also encourage researchers to consider innovative methods of dissemination where appropriate. We will be encouraging successful research teams to communicate the progress of their work from an early stage, and will be actively seeking to build linkages and share information where appropriate between the teams funded through this programme. We have established a Health Foundation Efficiency Research Programme Advisory Group, chaired by Peter Smith, Emeritus Professor of Health Policy, Imperial College, to support the stewardship of the Programme. You will be required to attend these meetings which will be held at least twice a year throughout the life of the programme. The primary purpose of the Advisory Group is to act as a critical friend and a connections facilitator to the research teams, and to encourage teams to share their progress with the other research teams funded through this programme. Secondary benefits may also include peer reviewing of outputs, identifying opportunities for dissemination, and assessment of any proposed variations to the programme plan. The Health Foundation will support dissemination of the research findings wherever possible, both during and after the completion of the research work. This might for instance include the development of a full published report based on the research findings, in addition to journal dissemination. 10/12

11 The budget The Health Foundation has 1.5 million to fund our ambitions for the Efficiency Research Programme. We anticipate funding between three to five research projects through the programme, with budgets in the range of 250,000 and 500,000. You may submit an application below 250,000, but you should be able to justify how your project will support our objectives for this programme to make a significant contribution at that scale. In exceptional circumstances we may consider funding a research idea beyond our maximum of 500,000. You will however need to present an excellent case for this based on the additional value and impact of the proposal. Please note that as a charity we will fund only the full directly-incurred costs of the research. We do not fund overheads. Furthermore, the research will be supported as a charitable grant and as such is not liable for VAT. Application and selection process Applicants must complete an online research proposal application form AIMS.health.org.uk. We would ask that you familiarise yourself with the online application portal at the earliest possible stage of your application as we may not be able to respond in a timely fashion to any technical queries as the deadline for applications nears. As such we strongly encourage early proposal submission to avoid any disappointment. To assist in preparing your application, a list of responses to frequently asked questions is available for download. The deadline to submit proposals is 23:59 Thursday 28 July The online application portal will not accept proposals submitted after this time. Longlisting of proposals will be completed by the end of August Longlisted proposals will then be externally peer reviewed. Shortlisting will be completed by mid-october Shortlisted proposals will be invited to attend an interview at our London offices. Interviews for research grants will take place on Wednesday 2 or Thursday 3 November Please ensure that you are available for interview on these dates, as we are unable to offer applicants alternate interview dates. If you have queries about the application process which have not been answered in our FAQs, please efficiency@health.org.uk in the first instance. We will endeavour to reply within five working days and, if appropriate, will also update the FAQs document. 11/12

12 Key dates Activity Date Deadline for applications 23:59 on Thursday 28 July 2016 Longlisting completed 31 August 2016 Peer review and shortlisting completed 30 September 2016 Applicants informed of interview w/c 17 October 2016 Interviews 2 or 3 November 2016 Applicants to be informed of final decision Late November /12