Commissioning Healthcare in England [book]

Commissioning Healthcare in England: Evidence, Policy and Practice
Edited by Pauline Allen, Kath Checkland, Valerie Moran and Stephen Peckham, April 2020

• A book bringing together research which the Policy Research Unit in Commissioning and the Healthcare System (PRUComm) has undertaken during the period 2011 to 2018. The analytical work supports understanding of how NHS commissioning operates and how it can improve services and access, increase effectiveness and respond better to patient and population needs.

NIHR Applied Research Collaborations (ARCs)

NIHR Applied Research Collaborations (ARCs) (launched 1 October 2019)

• NIHR ARCs (previously NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRCs), support applied health and care research that responds to, and meets, the needs of local populations and local health and care systems.
• The 15 local partnerships between NHS providers, universities, charities, local authorities, Academic Health Science Networks and other organisations also undertake implementation research to increase the rate at which research findings are implemented into practice. 
• Research priorities for the different ARCs.

National survey of local innovation and research needs of the NHS

National survey of local innovation and research needs of the NHS
AHSN April 2019

• Findings from a survey of clinicians and managers (n=257) to identify local NHS innovation and research needs in England indicates that the priory research needs were around workforce issues, mental illness, older people, frailty, multi-morbidities, use of technology and support for implementation of innovation.
•  Whilst there is a wide range of research taking place, the problem that many stakeholders identified was the lack of awareness of research and issues around implementation.

Patient and public involvement in research

Patient and public involvement in research: Enabling meaningful contributions
RAND Europe 2019

• Based on a rapid evidence assessment and interviews with experts, the report examines why and how patients and the public get involved with research, what enables meaningful involvement, associated challenges and potential enabling mechanisms, the impact of PPI, and the evaluation of this activity. 
• The report provides a series of recommendations  and other organisations to inform strategies for engaging patients and the public.
• Work commissioned by The Healthcare Improvement Studies (THIS) Institute at the University of Cambridge.

Involving NHS staff in research

Involving NHS staff in research
THIS Institute 7 February 2019

• This report explores why and how NHS staff (ie people directly and indirectly involved with delivery – everyone across clinical, managerial, administrative and support roles) contribute to research, the factors that enable engagement, the impact of engagement on research processes and outcomes, and the implications for future engagement efforts.

Better managing excess treatment costs

Better managing excess treatment costs
NIHR 26 October 2018

1. Following consultation the way in which excess treatment costs are met is changing and a trial period for the new arrangements will roll out from 1 October 2018, through to April 2019.
2. NIHR have published guidance comprising a flowchart of how ETCs will be covered for existing studies alongside worked examples.
3. The AMRC has published a blog on what this means for funders and a Q&A on the changes to the way in which ETCs are paid.

Supporting Research in the NHS: response to consultation on ETCs and commercial research

NHS England’s response to the public consultation: “Supporting Research in the NHS: A consultation covering changes to simplify arrangements for research in the NHS and associated changes to the terms of the NHS Standard Contract”
NHS England 4 May 2018

• A summary of responses received to the consultation on simplifying arrangements relating to Excess Treatment Costs (ETCs) in non-commercial research and commercial contract research. accompanied by details of 12 agreed actions to support and apply research in the NHS. 
• It includes key themes identified in the consultation responses, NHS England's response to these findings and a timeline for next steps.
• What will be implemented by April 2019
• Operation of refined ETC management models for CCG commissioned services using agreed CCG allocations and minimum 
• Trust thresholds for 2019/20 Operation of refined ETC management model for specialised commissioning services using agreed minimum Trust thresholds for 2019/20 
• Mechanism for assessing high value ETCs 
• Mechanism for ongoing evaluation and refinement of ETC management models 
• Continued oversight and reporting on ETC management models

How commissioners use research evidence

How commissioners use research evidence?
NIHR Dissemination Centre March 2018

• A summary of NIHR funded six studies into the behaviour of individual managers and the way in which commissioning organisations make sense of and use research information when making decisions.

See also The capacity of health service commissioners to use evidence: a case study

How can we all best use scientific evidence?

How can we all best use scientific evidence?
Academy of Medical Sciences June 2017

• A survey of British adults which indicated that only 37% of the public said they trusted evidence from medical research, compared to 65% who trusted the experiences of their friends and family. 
• The Academy of Medical Science has drawn up an action plan on how to make sure medical research is robust, relevant, trusted and that the evidence generated is useful and accessible to doctors and patients.

Towards affordable healthcare: Why effective innovation is key

Towards affordable healthcare: Why effective innovation is key
ILC-UK (International Longevity Centre), EY, 1 June 2017

• This report explores how health care innovations currently employed in the UK and abroad could increase productivity and reduce costs. 
• It showcases seven global and UK-based innovations with a strong evidence base of demonstrable success, and calculates the savings that could be achieved by implementing them across the UK. All case studies relate to out of hospital care.
• Analysis of these innovations indicate that, whilst the UK is well placed to innovate to improve health outcomes and reduce costs, the UK is often not doing enough with the tools at its disposal.

Building greater insight through qualitative research - Patient insight

Building greater insight through qualitative research
NHS England April 2017

• A basic introduction to qualitative research for those undertaking or commissioning research into insight into local healthcare experience and needs: what it is, what are its strengths and limitations compared to quantitative research. It outlines some methods, sampling techniques and ways to analyse the data.
• One of a series of bite-size Guides to Patient Insight available here.

Integrated health and social care 2020: research

Integrated health and social care 2020: research
SCIE March 2017

• Research to inform the Integration Standard and the next phase of the government’s plans to integrate health and social care.
• This report presents the findings from a programme of scoping research and engagement to:
• better understand what excellent integrated health and social care should look like in 2020
• test out the Integration Standard with national stakeholders and local areas
• provide feedback and support for further development of the standard.

Why did mortality in England and Wales increase in 2013-14?

Two research papers examine the increase in mortality in England and Wales 2013-14.

Why has mortality in England and Wales been increasing? An iterative demographic analysis
Journal for the Royal Society of Medicine, 16 February 2017

• An examination of the causes and ages at death contributing to life expectancy changes between 2013 and 2015 in England and Wales has found that the long-term decline in mortality has reversed, with approximately 30,000 extra deaths compared to what would be expected if trends in 2006–2014 had continued.
• These excess deaths are largely in the older population, who are most dependent on health and social care. The major contributor, based on reported causes of death, was dementia but caution was advised in this interpretation. 

What caused the spike in mortality in England and Wales in January 2015?

Journal of the Royal Society of Medicine, 16 February 2017

• The four possible causes of mortality spikes in a population are proposed as; data artefact; environmental shock (eg natural disaster or extreme weather event); a major epidemic or a widespread failure of the health and social care system.
• Given limitations of the evidence and its complexity, the researches cannot reach a firm conclusion about what has happened, but they point to possible lines of further inquiry, and discount some possible explanations. 
• While the reduced efficacy of the influenza vaccine being used may have played some role in the January 2015 mortality spike, this is likely to have been limited. 
• The research excludes common sources of data artefact. 
• Instead, the evidence points to a major failure of the health system, possibly exacerbated by failings in social care.

The London Quality Standards programme evaluation

The London Quality Standards: A case study in changing clinical care.
Nuffield Trust 14 February 2017

• From 2011, the NHS in London embarked on a major programme to improve care for patients in emergency and acute services by introducing a set of professional standards. The London Quality Standards (LQS) set out a range of minimum requirements, including regular consultant review during out-of-hours and at the weekends.
• This evaluation draws on surveys and interviews with those responsible for developing the standards and the frontline staff responsible for making them a reality. It found that the introduction of the LQS worked well in making people aware of shortcomings in care, and drove real change in how people worked, but initial statistical analysis did not show any evidence that they achieved consistent improvement in patient outcomes.
• The most important factor in making the standards a reality was a bottom-up effort from clinicians. There were some deficiencies in hospitals’ ability to manage complex changes, and evidence of a deep disconnect between frontline staff and top managers. The use of reconfiguration as a “stick” to drive the standards demotivated staff, and eventually came to be seen as an empty threat.

Understanding Health Research: A tool for making sense of health studies

Understanding Health Research: A tool for making sense of health studies
Population Health Sciences Research Network

• This tool is designed to help people understand and review published health research.
• The tool guides users through a series of questions to ask about specific types of health research, and helps users to understand what the answers to those questions say about the quality of the research they are reading.
• The website includes links to sites which publish critical appraisals of research, critical appraisal tools and reporting guidelines.

Brexit: the next steps for the UK’s withdrawal from the EU

Brexit: the next steps for the UK’s withdrawal from the EU
House of Commons Library

• The resource sets out research on the impact of Brexit on key policy areas and explains the process for leaving the EU.

Commissioning self management support - aspiration and reality

Commissioning of self-management support for people with long-term conditions: an exploration of commissioning aspirations and processes.
BMJ Open. 2016 Jul 15;6(7):e010853.

• Based on nine CCGs from the south of England, this research examines how self management support is delivered, from plans and aspirations to translation into commissioned services.
• The research was based on content analysis of CCG forward plans for mention of self management support, semistructured interviews with commissioners (n=10) and observations of governing body meetings.
• Despite the rhetoric of ensuring services are designed around patients' needs, the research found that patients and the public were not engaged in commissioning in meaningful ways and their voice was, almost entirely, absent.
• This study highlights where CCG aspirations and operationalisation do not align, and draws attention to where intentions are not being put into practice—effective self management support which is developed from the bottom-up.
• The research notes tensions between national NHS England guidance and local aspirations. While commissioners say that self management support is a priority, details of local initiatives were notably absent with austerity (cost-containment) and nationally measured biomedical outcomes taking precedence.

Public involvement in research

Public involvement in research
NHS Health Research Authority, INVOLVE 23 May 2016

• Joint publications outlining the evidence on how public involvement can help to make research more ethical and produce better outcomes, and guidance on public involvement within ethical review.

What happens when GPs engage in commissioning?

What happens when GPs engage in commissioning? Two decades of experience in the English NHS

J Health Serv Res Policy April 2016 vol. 21 no. 2 126-133

• Analysis of 218 published papers (published 1991 to 2010) by researchers from the Centre for Primary Care, University of Manchester concludes that there is limited evidence for a significant impact of clinical engagement on commissioning outcomes. While engagement of GP members of primary care commissioning organizations is an important determinant of progress, it generates significant transaction costs.       
• Research highlighted both 'virtuous cycles’ (experience of being able to make changes feeding back to encourage greater engagement) and ‘vicious cycles’ (failure to influence services generating disengagement).
• Engagement of the wider GP membership was an important determinant of success. Most impact was seen in GP prescribing and the establishment of services in general practices. There was little evidence of GPs engaging more widely with public health issues. Initial changes are likely to be small scale and to focus on services in primary care.

 

Factors influencing major service changes

Lessons for major system change: centralization of stroke services in two metropolitan areas of England
Journal of Health Services Research & Policy, 2016

• Research to identify the factors influencing the selection of a model of acute stroke service centralization to create fewer high-volume specialist units in two metropolitan areas of England (London and Manchester). 
• The study found that both system and clinical leadership is necessary to enable change.