Invitation to Tender Department of Health Policy Research Programme Summative Evaluation of the Integrated Personal Commissioning Programme in the Context of Wider Policy Reforms to Promote Better Integrated Care and Support in England Deadline for stage 1 applications: 1.00 pm on Tuesday 7 June 2016 Table of Contents INTRODUCTION .................................................................................................................. 3 Integrated Care and Support – Policy Context ................................................................... 4 Integrated Personal Commissioning Programme ............................................................... 6 Key features and policy objectives of the IPC programme ......................................... 6 IPC Overall Evaluation Strategy ................................................................................. 8 Key Success Criteria – Integrated Personal Commissioning Policy ............................ 8 Policy Purposes of the Evaluation ..................................................................................... 9 OVERALL REQUIREMENT ................................................................................................ 11 Evaluation Scope and Focus – Key Considerations......................................................... 11 Evaluation Aims and Objectives ...................................................................................... 12 Reflexive Learning ........................................................................................................... 13 Building on Related Research ......................................................................................... 13 Methodological Considerations ........................................................................................ 15 Commissioning Approach ................................................................................................ 16 DETAILED REQUIREMENTS ............................................................................................. 17 Overall Study Type and Design ....................................................................................... 17 Process Evaluation Strand........................................................................................ 18 Impact Evaluation Strand .......................................................................................... 19 Economic Evaluation Strand ..................................................................................... 22 Common Dataset (Management Information) .................................................................. 22 Reporting and Outputs .................................................................................................... 23 Evaluation Team ............................................................................................................. 24
GENERAL INFORMATION FOR APPLICANTS.................................................................. 25 Governance Issues.......................................................................................................... 25 Risk Management ........................................................................................................... 26 Patient and Public Involvement (PPI) .............................................................................. 26 Outputs and Reporting Arrangements ............................................................................. 26 Dissemination .................................................................................................................. 28 Time Scale and Budget ................................................................................................... 28 Transparency .................................................................................................................. 28 Application Process ......................................................................................................... 29 Selection Criteria ............................................................................................................. 30 Timetable ........................................................................................................................ 30 Contacts .......................................................................................................................... 31 References and Key Documents ..................................................................................... 32 ANNEX A Integrated Care and Support Policy and Legislative Context .............................. 34 ANNEX B Integrated Personal Commissioning Policy- Outline Description by NHS England ........................................................................................................................................... 38 ANNEX C Outline Description of Integrated Personal Commissioning Demonstrator Sites/Initiatives .................................................................................................................... 40
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INTRODUCTION 1.
The Department of Health (DH), in partnership with NHS England (NHSE), wishes to commission a summative evaluation of the Integrated Personal Commissioning (IPC) programme for health and care. The primary focus of the evaluation will be on the impact of the integrated personal commissioning programme in the context of wider policy reforms to promote better integrated care and support in England. The evaluation will build on scoping and early evaluation work already underway and, subject to feasibility, will yield robust evidence on the outcomes of integrated personal commissioning approaches for patients, users, carers, other key stakeholders, and for the health and care system, to inform future policy.
2.
The government believes that making person-centred, co-ordinated care and support the norm across the health and social care system in England over the coming years will improve the lives of vulnerable people, by giving them more choice and control, placing them at the centre of their own care and support, and providing them with a better service. To this end, the government has launched a number of policy initiatives designed to join up health and social care services at national and local levels, with a view to making joined up health and care the norm by 2018.
3.
In May 2013, the Department of Health and its partners launched Integrated Care and Support: Our Shared Commitment, which set out how local areas can use existing structures like Health and Wellbeing Boards to bring together local authorities, the NHS, social care providers, education, housing services, public health and others to make further steps towards integration. The aim is to make health and social care services work together to provide better support at home and earlier treatment in the community to prevent people needing emergency care in hospital or care homes.
4.
In June 2013, as part of the 2013 Spending Round, the government announced plans to create a pooled, dedicated £3.8 billion Better Care Fund. The Better Care Fund (BCF) is intended to provide the biggest ever financial incentive for localities to transform local services so that people are provided with better integrated care and support. Further provisions to help embed integrated care and support were included in the Care Act 2014, and outlined in the Transforming Primary Care vision document published in April 2014.
5.
In November 2013, DH and its partners launched a five- to seven-year programme of integrated care and support Pioneers in localities across England that are pioneering new ways of delivering co-ordinated care. The aim of the Pioneers programme is to spread learning and accelerate change by showcasing innovative ways of creating change in health and social care services.
6.
In July 2014, the Chief Executive Officer of NHS England, Simon Stevens, announced plans for a ground-breaking new Integrated Personal Commissioning programme which would “for the first time blend comprehensive health and social care funding for individuals, and allow them to direct how it is used”. Under the IPC programme, a combined NHS and social care funding endowment, blending funds contributed from Local Authorities (LAs) and Clinical Commissioning Groups (CCGs), would be created based on each individual’s annual care needs. High need individuals would be offered
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the ability to control their own blended NHS and community care, in partnership with the voluntary sector. It was announced at the same time that the programme would be independently evaluated. 7.
An IPC Prospectus, inviting local expressions of interest in bidding to become a designated IPC area, was issued by NHS England in July 2014. 1 In April 2015, the IPC programme was formally launched as a partnership between NHS England and the Local Government Association, in nine localities across England. The purpose of the IPC programme is to spread learning and accelerate change by demonstrating innovative approaches to empowering service users and delivering personalisation at scale for target populations.
8.
This invitation to tender sets out high level requirements and invites full applications by 1.00 p.m. on Tuesday 7 June 2016, for a rigorous summative evaluation of the IPC programme in the context of wider policy reforms to promote better integrated and personalised care and support.
9.
DH and its partners recognise that the evaluation requirements are challenging. On appointment, the successful evaluation team will be expected to work closely with DH, its partners and expert advisers, to refine details of the evaluation scope and focus, design and methods.
10.
The evaluation is expected to be conducted within a period of 24 months (two years) commencing in Autumn 2016, and the research contract will be funded up to a maximum sum of £800,000 (eight hundred thousand pounds). Release of funding beyond a 15 month break point in the contract will be conditional on satisfactory assessment and peer review of a scoping and feasibility report, including refined proposals for evaluation of process and outcomes. This report will be required in April 2017.
Integrated Care and Support – Policy Context 11.
As highlighted in the Spending Round 2013, in the context of growing demographic pressures the Government believes that encouraging and helping public services in a local area to work more closely together to cut out duplication and invest in reducing demand for costly services is one of the best ways to maintain the quality of services while reducing the cost to the taxpayer.
12.
In May 2013, the Department of Health and other national leaders of health and care issued ‘Integrated Care and Support: Our Shared Commitment’.2 This highlighted a need to create – at scale and pace – a culture of co-operation and co-ordination between health, social care, public health, other local services and the third sector,
1
NHS England (2014): Integrated Personal Commissioning Prospectus: making a reality of health and social care integration for individuals 2 National Collaboration for Integrated Care and Support (2013): Integrated Care and Support: Our Shared Commitment, May 2013.
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supported by new technology and shared information, in order to provide a seamless service focused on the individual within their own home.
13.
In June 2013, as part of the Spending Round 2013, a £3.8 billion pooled fund was announced to promote joint working between health and social care services in England. The Better Care Fund (BCF) provides for £3.8 billion worth of funding in 2015/16 to be spent locally on health and care through pooled budget arrangements to drive closer integration and improve outcomes for patients and service users and carers.3
14.
The wider policy and legislative context relating to the promotion of better integrated and personalised care and support for older people and those with complex conditions includes the following:
15.
“Transforming Primary Care: Safe, proactive, personalised care for those who need it most”, issued jointly by the Department of Health and NHS England in April 2014.4
The Care Act 2014, which passed into legislation on 14 May 2014.5
In January 2016, DH issued a Mandate to NHS England for 2016-17.6 In relation to DH’s objectives to improve out-of-hospital care the Mandate states: “We want to see more power and control devolved to more areas, enabling communities to design and develop new models of care tailored to meet the needs of their local populations. NHS England should support the NHS to achieve the Government’s aim that health and social care are integrated across the country by 2020, including through the Better Care Fund.” (p.10)
16.
In relation to DH’s objective to help create the safest, highest quality health and care service, the Mandate also sets a goal by 2020 for “50-100,000 people to have a personal health budget or integrated personal budget (up from current estimate of 4,000).”
17.
Further background information about the integrated care policy and legislative context is outlined at Annex A.
3
In April 2014, the Minister for Care and Support, Norman Lamb, announced that the size of the Fund had increased to £5 billion, reflecting additional contributions pledged by health and local authorities.
4
Department of Health and NHS England (2014): Transforming Primary Care: Safe, proactive, personalised care for those who need it most, April 2014 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304139/Transforming_primary_car e.pdf 5 Care Act 2014: http://www.legislation.gov.uk/ukpga/2014/23/contents/enacted/data.htm 6 Department of Health (2015): Mandate to NHS England 2016-17.
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Integrated Personal Commissioning Programme 18.
The IPC programme featured in the NHS Five Year Forward View published by NHS England in September 2014.7 In relation to the objective of empowering patients, this stated: “We will also introduce integrated personal commissioning (IPC), a new voluntary approach to blending health and social care funding for individuals with complex needs. As well as care plans and voluntary sector advocacy and support, IPC will provide an integrated, “year of care” budget that will be managed by people themselves or on their behalf by councils, the NHS or a voluntary organisation.” (p.13)
19.
An outline description of the IPC programme by NHS England is at Annex B. This supplements the IPC ‘roadmap for delivery’ document made available earlier to potential applicants.
Key features and policy objectives of the IPC programme 20.
According to NHS England, the ultimate aims of IPC are to improve quality of life, enable people to achieve outcomes that matter to them, and prevent crises in people’s lives that lead to unplanned hospital admissions or institutional care.
21.
It is a new approach to joining up health, social care and other services at the level of each individual. It enables people, carers and families to control the resources available and to shape their own care. It also supports people to make the most of the community resources around them and to develop their knowledge, skills and confidence for self-management. It does this through targeted peer support, community capacity building and an expanded role for the VCSE sector in preventing, reducing or delaying the need for crisis intervention and acute care.
22.
IPC is delivered through enhanced multi-disciplinary teams drawing together generalist, social, mental and specialist care with the voluntary sector into IPC Hubs. This means a completely different approach to planning and commissioning community, social care and other services and the adoption of evidence based approaches to delivering personalisation at scale for target populations.
23.
The emerging IPC framework is characterised by 5 key shifts in the model of care, underpinned by a number of specific service components. Together these drive improved outcomes for people, the system and the tax payer. The 5 shifts are:
7
NHS England et al (2015): Delivering the Forward View: NHS Planning Guidance for 2016/17-2020/21
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i.
Integration around the individual: A targeted approach to delivering person-level, integrated care for people with complex needs
ii.
Community capacity and peer support: A community and peer focus to build knowledge, skills and confidence for self-management
iii.
Person-centred planning: A different conversation about health and care focused on what’s important to each person, through person-centred care and support planning
iv.
Choice and control: A shift in control over the resources available to people, carers and families, through integrated personal budgets
v.
Personalised commissioning and payment: A wider range of care and support options tailored to individual needs and preferences, through personalised commissioning, contracting and payment
24.
This emerging framework is based on learning so far and will evolve further as the programme progresses. The detail of the model is being co-produced in partnership with demonstrator areas through a collaborative development process, supported by rapid cycle implementation and local evaluation.
25.
In 2015/16 there were 9 demonstrator sites. Further information on each site is outlined at Annex C.
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26.
The number of sites may change as the IPC programme moves into the next phase. Memoranda of Understanding (MOUs) are currently being negotiated for the second year of the programme with deliverables being agreed. It is expected that most of the existing 9 sites will continue into Year 2. It is also planned to launch a second wave of up to 10 more IPC sites in 2016/17. Although these will be 12-18 months behind the Wave One sites, it may be possible to include some activity from a small number of Wave Two sites that develop local capacity quickly and have the potential to yield relevant learning.
IPC Overall Evaluation Strategy 27.
28.
The independent summative evaluation is one of four work streams that make up NHSE’s overall evaluation strategy for the IPC programme: i.
Stream One was undertaken by RAND Europe, and concentrated on working with sites to define local logic models and develop an initial logic model for IPC. RAND Europe’s confidential draft report on this stream of work has already been made available to applicants.
ii.
Stream Two is a scoping and early evaluation study being carried out jointly by the Policy Innovation Research Unit (PIRU) and the policy research unit in Economics of Health and Social Care Systems (ESHCRU), which is due to complete later this year. Draft output from this stream of work will be made available to assist in the development of applications.
iii.
Stream Three is being undertaken by an NHSE local evaluation team. It will concentrate on local evaluation with sites to provide rapid feedback on learning and experiences from the early implementation stage of IPC and to finalise core and local metrics.
iv.
Stream Four is the independent summative evaluation programme, the high level requirements for which are set out in this invitation to tender.
The successful evaluation team will be expected to co-ordinate activity with IPC local evaluation activity as far as possible and appropriate, to ensure that data collection burden is minimised and potential duplication avoided. A confidential copy of NHSE’s draft Local Evaluation Strategy can be made available to potential applicants on request, to assist development of proposals.
Key Success Criteria – Integrated Personal Commissioning Policy 29.
Key policy success criteria for the integrated personal commissioning programme relate to the wider policy aims of improving effectiveness and the experience of patients and users; removing gaps and duplications in services and achieving greater economies of scale; promoting equality and improving access for all; and avoiding admissions to hospital or a care home and facilitating timely discharge from hospital. The integrated personal commissioning programme will also be judged on its impacts on the wider system of health and social care, and on its cost-effectiveness – including any impacts on the provision or cost of services, including for those people who are not eligible for / do not use personal budgets to purchase health, care and related services. In particular, the goal is to join up NHS and social care services and radically reform the way in which health and care are delivered in order to help keep people living
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independently at home, get them out of hospital more quickly and prevent them from needing more support. 30.
According to NHS England, if successful, the IPC programme will have a positive impact at the individual, professional and system levels:
Individuals and their families will have improved quality of life and a reduction in the need to access acute or emergency services. They will experience more coordinated proactive care and support which focuses on what is important to them. They will be able to take more control though the flexible use of integrated budgets
Professionals will have the skills and tools to support people in a more personcentred way, to be able to help people create bespoke solutions which meet their needs rather than be limited to solutions traditionally provided. They will see the positive impact on individual’s lives.
The system will benefit through reduced costs of acute and institutional care. Linked datasets will mean that commissioners across health and social care have a greater understanding of the services used by individuals so are better able to commission integrated care and support which fits with local needs and preferences. Providers will see a reduction in unplanned reactive care, reducing pressure on the system. There will also be a positive impact on voluntary sector providers who will be more involved and there will be greater investment in services that support self-management. Niche providers will benefit as individuals choose to use their services.
31.
Success criteria and approaches to measurement, including potential quality and outcome measures, are expected to be looked at in more detail as part of early scoping and feasibility work, drawing on expert input and advice from government, its partners and academic advisers. Applicants will have access to preliminary advice as early learning to facilitate development of proposals.
32.
Additionally, a number of scheme-specific success criteria may be developed, dependent on the particular approach being implemented and the local context. The evaluation team will be required to agree any additional context-specific success criteria both with the IPC areas and with NHS England and DH prior to the commencement of data collection.
Policy Purposes of the Evaluation 33.
The policy purposes of the proposed evaluation of the IPC programme in the context of wider policy innovations designed to promote better integrated and personalised care and support, will be to: a) Help Ministers and policymakers judge the overall success (or otherwise) of the IPC programme b) Inform an assessment of the overall value for money delivered (or otherwise) by the IPC programme c) Understand whether or not implementation has been successful, and the factors contributing to this, in order to learn lessons for improvement in future
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d) Spread learning in real-time on what works in delivering quality integrated personal commissioning e) Help build the evidence base on what works in delivering quality integrated care and support 34.
Applicants should note that the NHS England is working closely with local IPC ‘demonstrator’ sites with a view to developing standard replicable models for IPC to be introduced within 12 months. Thus a key purpose of the evaluation will be to develop the research evidence base on what works (or does not work) in the delivery of these standard models of integrated personal commissioning for adults and children with complex, long-term needs, and why, in order to spread learning in real time and inform potential future guidance in this area.
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OVERALL REQUIREMENT 35.
The overall requirement is for a summative evaluation of the impacts of the Integrated Personal Commissioning programme, in the context of wider policy reforms designed to promote better integrated care and support for older people and those with complex needs, with particular reference to: a) outcomes and user experience, b) economic and financial impacts, and c) wider system effects.
Evaluation Scope and Focus – Key Considerations 36.
The scope of the proposed evaluation is expected to extend to a range of IPC approaches in Wave One demonstrator sites across England, including the arrangements for supporting and funding IPC initiatives. The scope may also include Wave Two demonstrator sites which are scheduled to start in 2017. Decisions about whether or not to include Wave Two sites will need to be made in consultation with DH, NHSE and their partners before data collection starts.
37.
The proposed evaluation is expected to extend to each of the four population groups identified as falling within the scope of the IPC programme, and their carers:
38.
Children and young people with complex needs, including those eligible for education, health and care plans
People with multiple long-term conditions, particularly older people with frailty
People with learning disabilities with high support needs, including those who are in institutional settings or at risk of being placed in these settings
People with significant mental health needs, such as those eligible for the Care Programme approach or those who use high levels of unplanned care
It is envisaged that the scope of the evaluation will extend to the range of IP programme components, which broadly include:
A financial model for budget setting across sectors and allocation of a single integrated budget – with a system for sharing information across sectors, review and shaping of the provider market by commissioning organisations, development of community and voluntary sector assets, etc.
A care model giving patients, users and their carers more control to shape care and receive support that is meaningful to them – including personalised care and support planning, independent advocacy, peer support and brokerage, integrated personal budgets, etc.
39.
Although no IPC component is ruled out of consideration at this stage, a particular focus of interest will be on identifying and evaluating those elements of the IPC approach that are novel and untested.
40.
Applicants will be required to take into consideration the wider policy and practice context relating to integrated health and care services for older people and those with complex needs, including the Care Act 2014, the Transforming Primary Care vision
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document, and NHSE’s New Models of Care programme. The evaluation will also be required to take into account any key integrated care policy developments that may emerge in future. 41.
Unless for the purpose of comparison, the scope of the evaluation is not intended to extend to commissioning arrangements for older people or adults and children with complex needs that do not incorporate better integrated and personalised care and support as a specific design feature, nor to local areas that are not designated as IPC demonstrator sites, nor to local areas that do not receive IPC funding support.
42.
Given the broad scope of the Department of Health’s and NHS England’s policy interest, on appointment the successful evaluation team will be expected to work closely with DH, NHSE, their partners and expert advisers to refine details of the evaluation scope and focus. It is also expected that service users will be involved in the process of refining the evaluation approach.
Evaluation Aims and Objectives 43.
44.
45.
The overall aim will be to assess whether, how and to what extent IPC approaches to promoting better integrated and personalised care and support can lead to better overall quality and outcomes of care, and value for money. To this end, the evaluation should gather data to allow comparative analysis of:
economic impact of IPC across health, social and educational sectors
a range of patient outcomes (and carer outcomes, where appropriate) including quality of life, experience and empowerment
wider issues of equality/inequality, community empowerment, market formation and impact on commissioning and contracting
Subject to feasibility, key objectives of the evaluation will be to:
Robustly assess the effectiveness of the IPC financial and care model approaches against key process and outcome measures, for example in the domains of personalisation, choice and control, health and wellbeing.
Undertake an economic evaluation of IPC approaches, and of the IPC programme as a whole.
Identify and disseminate (in collaboration with NHSE and its partners) the key lessons for ensuring the quality, effectiveness and efficiency of IPC models in the future.
Specific areas for consideration are expected to include, but are not limited to, for example:
The uptake and impact of IPC care model approaches among population groups with complex and long-term needs
The impact of IPC care model approaches on patients and users who either are not eligible for or do not take up care and support services, and on staff working in community, primary care, hospital or other settings.
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46.
The impact of IPC care model approaches in community or hospital settings, on a range of key stakeholders, including providers of community services, care home providers, health and local authority commissioners, and on the wider social and health care provider market.
The impact of IPC approaches on commissioning and provision of care and support.
The impact of IPC approaches on costs and price of integrated and personalised care and support service delivery, on patterns of resource use, and on cost and efficiency savings.
As indicated above, the summative evaluation of the IPC programme must be set in the wider policy context of new funding and wider support arrangements for local integrated and personalised care and support schemes – including the Pioneer support arrangements, the BCF and any subsequent planning, funding and budgetary arrangements, and relevant policy developments in primary care, social care and other areas.
Reflexive Learning 47.
The evaluation approach is expected to build in structured opportunities for dynamic evaluative feedback and reflexive learning for IPC sites and policy makers. Applications should set out ways to achieve this that are efficient and effective.
Building on Related Research 48.
49.
In addition to NHSE’s IPC Local Evaluation Strategy, applications will be expected to have regard to findings from related research. For example, integrated care policy development has been informed by earlier DH-funded policy evaluations including:
Evaluation of the individual budgets pilot programme8
Evaluation of the personal health budget pilot programme9
Evaluation of the direct payments in residential care trailblazers (in progress)10
Applicants should note that a DH-funded scoping and early evaluation of the integrated care and support Pioneers programme in the context of the BCF and wider integrated care policy has also now reported.11
8
Glendinning C et al (2008): Evaluation of the individual budgets pilot programme – final report, Social Policy Research Unit, University of York, 2008. http://php.york.ac.uk/inst/spru/research/summs/ibsen.php
9
Forder J et al (2012): Evaluation of the personal health budget pilot programme, Personal Social Services Research Unit Discussion Paper 2840_2, November 2012. https://www.phbe.org.uk/
10
Policy Innovation Research Unit: http://www.piru.ac.uk/projects/current-projects/direct-payments-in-residentialcare-evaluation.html 11 Policy Innovation Research Unit: http://www.piru.ac.uk/projects/current-projects/integrated-care-pioneersevaluation.html
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50.
Importantly, applicants should note that DH is funding a scoping and early evaluation of the IPC programme, which started in December 2015 and is expected to complete in October 2016. The aims of this primarily qualitative evaluation, being carried out jointly by the Policy Innovation Research Unit (PIRU) at the London School of Hygiene and Tropical Medicine and the policy research unit in Quality and Outcomes of PersonCentred Care (QORU) at the University of Kent, are to investigate:
Progress on implementation of key activities, and the nature of the financial model
The challenges facing each pilot and how they adapt
Key outputs such as numbers and types of people being offered personalised care plans, budgets etc., services purchased, and impact on overall service use and costs per person
Potential impacts
Implications for planning the main evaluation phase
51.
This scoping and early evaluation of the IPC programme follows an initial study referred to earlier, commissioned by NHS England and carried by RAND Europe, the draft report on which was made available to potential applicants at the Expression of Interest stage. Early output from PIRU’s / ESHCRU’s scoping and early evaluation study will be made available to applicants to assist development of proposals and help ensure a level playing field for commissioning of the IPC main evaluation phase.
52.
Further related DH-funded work includes:
53.
Evaluation of the integrated care pilot programme12
Reports on measurement of people’s experience of integrated care13 14
Evaluation of the integrated care and support Pioneers programme in the context of new funding arrangements for integrated care in England (in progress)15
System-level evaluation of the Better Care Fund (in progress)16
Plans are also in progress to commission an evaluation of NHS England’s (New Models of Care) Vanguards programme,17 and the proposed Proactive Care Programme in primary care.18
12
RAND Europe, Ernst & Young LLP (2013): National Evaluation of the Department of Health’s Integrated Care Pilots, March 2013 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215103/dh_133127.pdf 13 Raleigh V, Bardsley M, Smith P, Wistow G, Wittenberg R, Erens B and Mays N (2014): Integrated care and support Pioneers: Indicators for measuring the quality of integrated care, Policy Innovation Research Unit, April 2014. http://www.piru.ac.uk/assets/files/IC%20and%20support%20Pioneers-Indicators.pdf 14 Graham C, Killpack C, Raleigh V, Redding D, Thorlby R, Walsh J (2013): Options appraisal on the measurement of people’s experience of integrated care, Picker Institute Europe, March 2013 http://www.pickereurope.org/assets/content/pdf/Project_Reports/P2636_Integrated%20care%20report_post%20fi nal%20edits_v7%200.pdf 15 Policy Innovation Research Unit: http://www.piru.ac.uk/projects/current-projects/integrated-care-pioneersevaluation.html 16 Quality and Outcomes of person-centred care Research Unit: http://www.qoru.ac.uk/ 17 NHS England: https://www.england.nhs.uk/ourwork/futurenhs/new-care-models/ 18 NHS England has announced plans to commission a Proactive Care Programme evaluation on a consultancy basis.
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54.
The successful IPC programme evaluation team will be expected to build on the findings of related research and analytical studies over the period of the evaluation, take account of relevant new research and evaluations in planning, and develop collaborative links as appropriate.
55.
The successful evaluation team will also be expected to engage with DH’s Integrated Care Policy Evaluation Reference Group (ICPERG) which comprises key stakeholders and integrated care policy evaluation experts, and meets approximately twice a year.
Methodological Considerations 56.
To deliver a robust evaluation of outcomes (as distinct from process) requires a clearly defined intervention, target population group, and success criteria, as well as a sufficiently large cohort or sample of subjects to enable measurement of impact, and the availability of good controls to allow measurement of the “counterfactual” (i.e. the impact of no intervention). DH and NHSE recognise that the IPC programme is characterised by a range of approaches with different interventions, target population groups and success criteria, and that the availability of suitable comparator sites for assessment of impact is limited. Taken together, these characteristics present significant challenges for planning the delivery of a robust outcomes evaluation.
57.
Applicants will be expected to overcoming these challenges evaluation. In particular, DH is controlled) research design, and approach will be needed.
58.
In view of NHSE’s policy intention to roll out the IPC programme more widely, rather than comparisons between IPC commissioning approaches / models with standard approaches, a research design that allows comparisons between different IPC commissioning approaches / models in order to identify the best configuration of IPC components, and focuses on identifying mechanisms of change, is envisaged considered. A methodological approach is not prescribed however, and applicants will need to consider potentially feasible options in the light of the evaluation purpose and objectives.
59.
Proposals for research design will be expected to draw on the detailed description of IPC approaches being delivered as part of the scoping and early evaluation of the IPC programme already underway.
60.
On appointment, the successful evaluation team will be expected to work closely with DH, NHSE, their partners and expert advisers to further map IPC initiatives, scope the methodological challenges in more detail, assess whether delivery of a robust outcomes evaluation is feasible or not, and further refine the evaluation proposal. As
propose imaginative methodological approaches to and delivering a feasible and robust outcomes seeking imaginative proposals for comparative (or it is anticipated that a highly selective and pragmatic
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part of this, the evaluation team will be expected to discuss with DH, NHSE and their partners suitable comparators for the purpose of outcomes and economic evaluation.
Commissioning Approach 61.
The evaluation is being commissioned using a two-stage application process. Following the initial expressions of interest stage, those applicants successful at the short listing stage are now being invited to submit a full application setting out broad options for research questions, scope, design and methods. Full applications will be assessed against the criteria listed at paragraph 108 below, with a view to appointing an evaluation team to start in Autumn 2016.
62.
The integrated care and support and personalisation policy environment is a dynamic one. The IPC programme is being developed during 2015 and 2016 through partnership working between the IPC sites and NHS England, and it is envisaged that a second wave of IPC sites will be appointed to start in 2017. The national planning and funding arrangements for integrated care and support may also change and develop over time. This means that the detailed shape and operation of the IPC programme and the funding environment is subject to uncertainty and is likely to evolve over time. It may not be feasible therefore, for applicants to develop definitive evaluation proposals, particularly in relation to evaluation of outcomes.
63.
In anticipation of any changes in the IPC policy environment, DH will hold open the option of convening with its partners an evaluation briefing or workshop event in Winter 2016 for the appointed evaluation team. The purpose would be to support the appointed evaluation team in understanding the policy context and any implications for the evaluation requirement, as appropriate.
64.
As indicated above, so that the appointed evaluation team will have suitable scope to refine their plans, an initial review milestone will be built into the research contract. Release of funding beyond a 15 month break point in the contract will be conditional on satisfactory assessment and peer review of a full scoping and feasibility report that will include refined evaluation proposals, particularly in relation to evaluation of outcomes and economic evaluation. This report will be required in April 2017. There will be an opportunity to adjust and reprofile the budget for the study at this point, if appropriate.
65.
Proposals for the main evaluation phase will be expected to build on the IPC early evaluation currently in progress, and must not duplicate or overlap in an unhelpful way with the early evaluation. Outputs from the early evaluation of the IPC programme will be shared with applicants as they become available.
66.
During the first four to six months of the study, the appointed evaluation team will be expected to work closely with DH, NHSE and its partners and with the IPC demonstrator sites, to investigate the feasibility of delivering an impact evaluation of the IPC programme, as well as collecting baseline and other data where appropriate. Relevant expert input and advice obtained during the scoping and early evaluation of the IPC programme will be made available to the evaluation team as early learning to inform and facilitate this phase of their work.
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DETAILED REQUIREMENTS Overall Study Type and Design 67.
It is anticipated that the summative evaluation will include both qualitative and quantitative methods. While qualitative research will have an important role to play in understanding the context for the relevant actors and outcomes, DH and NHS England are also keen to understand the impact of IPC innovations on patient / user outcomes at population level, as well as any impact on provider behaviour, overall integration of care, and sustainability of financial models.
68.
A complex, multi-stranded evaluation programme is envisaged. The evaluation team will be expected to undertake a modest process evaluation and a robust impact evaluation in order to identify why and for whom IPC initiatives might work, and to draw valid and reliable conclusions that can be transferred to best practice across health and care sectors. This will include an economic evaluation of IPC initiatives.
69.
A programme-wide process evaluation (perhaps using a more light touch approach in selected sites), complemented by a robust impact evaluation in selected IPC areas is envisaged. This approach is not prescribed however, and we would welcome applications that set out an alternative approach where this is well-justified.
70.
Selection of the IPC areas to include in the evaluation, including selection criteria, must be discussed and agreed with DH and its partners before data collection / analysis commences. The selection of IPC areas is expected to be shaped primarily by scientific considerations, including the outcome of scoping and feasibility work. The appointed evaluation team should also retain the flexibility to focus on specific aspects of the integrated personal commissioning policy programme depending on priority policy needs, as appropriate.
71.
The study is expected to start with a preliminary scoping and feasibility phase, and will build on the early evaluation of the IPC programme already underway.
72.
Applicants will be expected to detail a robust approach to co-ordination and integration of the different evaluation strands as part of the evaluation management arrangements.
Preliminary Scoping and Feasibility Phase 73.
During the first four to six months of the study, the appointed evaluation team will be expected to work closely with DH and its partners, and with the IPC demonstrator sites, to investigate the feasibility of delivering an impact evaluation of IPC approaches, as well as collecting baseline and other data where appropriate. A full scoping and feasibility report will be required, that will include refined evaluation proposals, particularly in relation to evaluation of outcomes and economic evaluation. Building on the RAND Europe report and the early evaluation study already underway, the report will be expected to refer to and take account of relevant research evidence on the
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effectiveness, including cost-effectiveness, of different models of integrated care and support. 74.
The report is expected to be published.
Process Evaluation Strand 75.
A modest process evaluation of IPC approaches is required to identify the key lessons for ensuring the quality, effectiveness and efficiency of IPC schemes in the future. There are a number of issues to explore in the process evaluation: for example, the different funding and delivery models and provider partnerships used, the care / support services provided and how they are commissioned, IPC schemes’ assessment and selection processes, patterns of eligibility and assessment for care and support, stakeholders’ views and experiences of the care / support services provided, and the costs of IPC schemes. The remainder of this section outlines the intended areas of focus, albeit this is not intended as a comprehensive overview. We welcome proposals for additional areas of focus for the process evaluation.
76.
There is a requirement for an updated description of IPC schemes, the context in which they are set, and the underlying logic models on which they are based, building on the initial work by RAND Europe and the early evaluation of the IPC programme in progress. This might include for example a description of the arrangements for: Identifying care options for consideration Supporting individuals, their families and carers in making choices Vetting agreed care plans for appropriateness Pooling budgets across different sectors Holding, setting and disbursing budgets, and monitoring their use Sharing data across organisational boundaries
77.
The process evaluation will document by patient / user group the care / support services provided, including any changes in pattern of service / resource use, and identify what is new or additional. It will also describe how IPC schemes are implemented across the different areas, identifying the strengths of the services and success factors, as well as any difficulties and how they were overcome.
78.
This could include for example the ease of patient / user access to personal budgets and personalised care planning, the arrangements for supporting patients, users and carers in accessing personal budgets and personalised care planning, the responsiveness of health and local authorities to supporting use of IPC schemes, and the responsiveness of providers to delivering integrated packages of care and support.
79.
This should also include a specific focus on cross-sectoral partnership working between commissioners, community and care home providers, and care professionals. There is specific interest in understanding the role of social work and other professionals in the delivery of integrated care and support schemes, particularly in relation to eligibility and assessment, care management and care co-ordination functions. There is also interest in understanding the quality of the process around IPC programme planning and BCF planning and resource allocation processes.
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80.
In relation to assessment and take-up, the process evaluation will document how many and what types of patients, users and carers are using or purchasing IPC-financed services, and how many and what types of eligible patients, users and carers do not take up IPC integrated care and support provision, with specific reference to selection issues such as health or local authority assessment processes and exclusion criteria. A specific focus on health equity and inequalities will also be relevant.
81.
An important aspect of the process (or outcomes) evaluation will be to understand patients’, users’, carers’ and stakeholders’ views and experiences of integrated care and support provision: for example, what users and carers think about the care and support provided, the quality of the care and services they receive or commission, and their overall levels of satisfaction with the care received. Patients’, users’ and carers’ perceptions of the impact of IPC initiatives on their ability to exercise choice and control, and to secure more personalised care, are of particular interest.
82.
Another important aspect of the evaluation will be to understand how patient and user views and experiences differ according to patient / user characteristics, for example age, social functioning, health and disability (including long-term conditions), socioeconomic group, ethnicity and gender. Applicants should explain how they would ensure that analysis by user sub-group could be undertaken, and how the equalities impact on groups with protected characteristics, including impact on differential access to / uptake of IPC-funded services, could be assessed. A particular focus of interest is the experience of patients / users with dementia and other conditions associated with impaired choice and control.
83.
A further requirement, to inform the economic evaluation, is to understand how much it costs to set up and run IPC initiatives, including the cost of assessment procedures and calculation / allocation of integrated personal budgets. This should also include indirect costs, such as any changes in provision and prices of services to patients / users who do not take up services.
84.
It is important that data collection burden on IPC areas is minimised. Where possible, the study should make use of any existing sources of secondary data that can inform a process evaluation of the IPC programme. This could include for example, Hospital Episode Statistics, the Personal Social Services Adult Social Care Survey for England, and the Personal Social Services Survey of Adult Carers in England. Where additional data are required, applicants should build in sufficient time to allow for negotiating access to providers as appropriate.
Impact Evaluation Strand 85.
Impact evaluation is required to assess robustly the effectiveness of the IPC approaches against key outcome measures, for example in the domains of health and wellbeing, choice and control. The impact evaluation, subject to feasibility, is expected to address the following key questions:
Do patients / users of the IPC care and financial approaches experience more choice and control over the care and services they receive compared with those
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86.
87.
who are not eligible for / do not use the IPC care and financial model approaches, do they experience better quality and outcomes of care, and are they more satisfied with their care? Do IPC schemes work better for some types of patients, users and carers than for others? What are the characteristics of IPC schemes that lead to successful outcomes? Do integrated care approaches in IPC areas provide better value for money, and are these approaches cost-effective? Are there any unexpected effects (positive or negative)?
The evaluation team will be expected to investigate the impact of the IPC programme, in the context of wider integrated and personalised care policy initiatives, on quality of care relative to the care planning baseline with specific reference to:
user and carer outcomes, including exploration of whether the definition of outcomes differs between individuals and professionals
user experience of care (based upon evaluation data collection instruments, or routinely collected data)
There is a requirement also to understand the impacts of IPC innovations on the NHS and wider health and social care system. This could include for example impacts on:
changes in the provider market
changes over time in service types, demand and efficiency
geographical patterning of provision
integration across care system and organisational boundaries
establishment of new organisations designed to deliver innovative integrated care schemes
health and care staff deployment, training and support
88.
Applications should specify approaches to measurement of choice and control, quality of care, and intermediate and final outcomes in the health and wellbeing domain for the purpose of the impact evaluation. These should take into account established measures used in government and in the research domain. There is a range of validated standardised tools available for measuring quality and outcomes of care relevant to integrated care and support schemes. Applications should mention any tools that will be used to measure impact on integrated care quality and outcomes and why these have been chosen.
89.
The feasibility and desirability of conducting an impact study is dependent on a number of factors such as practical implementation and value for money. Local design and implementation of the schemes and services that operate in each IPC area mean that there are a number of distinct models to be evaluated, though similarities in models between IPC demonstrator sites may be apparent. Some areas may not lend themselves to experimental evaluation approaches.
90.
Applicants must consider how best to establish an appropriate baseline against which to measure impact, taking into account the minimum dataset being introduced to the
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IPC programme, and including the feasibility and desirability of implementing a randomised controlled policy evaluation design. 91.
As outlined earlier, release of funding beyond a 15 month break point in the contract will be conditional on satisfactory assessment and peer review of a full scoping and feasibility report, including refined proposals for evaluation of outcomes and economic evaluation. This report will be required in April 2017. The refined proposals should address ways in which IPC scheme eligibility and assessment issues, and provision and commissioning processes, will be taken into account in evaluating impact for example on choice and control, and quality and outcomes of care.
92.
Subject to feasibility, it is envisaged that an impact evaluation will be undertaken for several selected IPC areas, to underpin the validity and reliability of the findings. This approach should also minimise the risk of no impact data being collected should it emerge that an impact study is not feasible in practice for a given area. The selection of IPC areas, initiatives or schemes for impact evaluation must be discussed and agreed with DH and its partners before impact data collection / analysis commences.
93.
Applicants should consider what approach will be taken to estimating cohort or sample sizes for the impact evaluation, and should explain how power calculations will be produced. It will be important that cohorts or samples are of sufficient size to enable impact to be detected.
94.
It is important that data collection burden on IPC areas is minimised. There are a number of existing sources of secondary data that might inform an impact evaluation of the integrated care and personalised care policy initiatives. These include for example Hospital Episode Statistics, the Personal Social Services Adult Social Care Survey for England, the Personal Social Services Survey of Adult Carers in England, the NHS Outcomes Framework, and the Adult Social Care Outcomes Framework.
95.
We welcome suggestions about sources of secondary data that might be used in the evaluation, especially in relation to accessing and tracking different IPC cohorts, and whether additional data on impact are required to be collected via the IPC schemes and / or service providers and users.
96.
As part of the early evaluation of the Pioneers programme, a report of advice on candidate indicators for measuring the quality of integrated care, commissioned by DH, was published in April 2014.19 Applicants are expected to take the report recommendations into consideration in selecting measures of integrated care quality. Applicants will also be expected to take into account recent DH-funded reports on measurement of people’s experience of integrated care,20 21 including any measurement approach that is adopted by NHS England in future.
19
Raleigh V, Bardsley M, Smith P, Wistow G, Wittenberg R, Erens B and Mays N (2014): Integrated care and support Pioneers: Indicators for measuring the quality of integrated care, Policy Innovation Research Unit, April 2014. http://www.piru.ac.uk/assets/files/IC%20and%20support%20Pioneers-Indicators.pdf 20 Graham C, Killpack C, Raleigh V, Redding D, Thorlby R, Walsh J (2013): Options appraisal on the measurement of people’s experience of integrated care, Picker Institute Europe, March 2013 http://www.pickereurope.org/assets/content/pdf/Project_Reports/P2636_Integrated%20care%20report_post%20fi nal%20edits_v7%200.pdf
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Economic Evaluation Strand 97.
Economic evaluation is required to assess whether, and if so to what extent, IPC approaches deliver efficiency and cost savings and represent good value for money in terms of the impact realised. Economic evaluation is also required to assess the impact of innovative IPC approaches on commissioning behaviour and provision of care / support, on patterns of resource use, and on the economic behaviour of providers in the market.
98.
An economic evaluation should be conducted for all IPC schemes included in the impact evaluation, using appropriate methods, although the method of economic evaluation may vary from area to area. Applications should consider how a value for money evaluation could be carried out in any IPC site where an impact evaluation is not undertaken, and the extent to which a programme-wide economic evaluation can be undertaken. The selection of IPC areas, initiatives or schemes for economic evaluation must be discussed and agreed with DH and its partners before data collection / analysis commences.
99.
As part of the economic evaluation, there is a requirement to understand how much it costs over time to set up and run IPC innovative integrated and personalised care and support initiatives, including transitional costs (such as IT, staff training and potential double-running costs), costs to local health and social care economies associated with care pathway redesign, and costs of supporting and monitoring budget deployment. There is also a requirement to understand what are the other costs such as wider health and social care and economic productivity costs. Applications will need to set out how these costs are to be assessed.
Common Dataset (Management Information) 100. Applicants should describe proposals for accessing and analysing relevant data as part of the IPC evaluation, including obtaining approval for accessing and matching data in compliance with data protection protocols. 101. A standard set of performance metrics is being developed as part of the IPC programme, and will be made available prospective applicants if possible to assist in development of applications. At present however, no standard data are being collected across IPC demonstrator sites.
102. Beyond this, the evaluation team will be responsible for advising on and potentially overseeing the collection of any additional management information from the IPC 21
King J, Gibbons E, Graham C, Walsh J (2013): Developing measures of people’s self-reported experiences of integrated care, Picker Institute Europe, October 2013. http://www.pickereurope.org/assets/content/pdf/News%20releases/Developing%20measures%20of%20IC%20re port_final_07012014.pdf
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areas that may be required to develop a common dataset, to ensure a consistent approach and that these data inform and benefit the evaluation.
103. Some areas may have existing databases they are intending to use to capture integrated care and support management information, while others will need to set up a system. Building on the early evaluation of the IPC programme already underway, an early task for the evaluation team may therefore be to understand what data are currently being captured by the IPC demonstrator sites and what additional data may be needed. Applicants should include what they see as the priority areas for management information in proposals.
104. Proposals will need to describe how this aspect of the project would be undertaken, taking into full account the information governance issues that must be considered when sharing personal data between a number of organisations, including governmental organisations. This includes issues such as:
Ensuring that the commitments that are given to participants about sharing their personal information accurately reflect the proposed uses of the data. Offering a ‘consent to share’ option and providing adequate information to enable participants to understand the implications of agreeing to this option. Developing robust information sharing protocols. Developing a ‘safe haven’, where linkage and analysis of personal data can be performed by a small number of staff, thereby bypassing the need to share identifiable information more widely.
105. It is important that applicants set aside sufficient time for the development of robust data sharing agreements with government and other national bodies, as appropriate. Where transfer or sharing of personal data is required, the wording of consent forms must be discussed and agreed in advance with DH and its partners.
Reporting and Outputs 106. The evaluation team will be required to produce the following outputs / reports:
In April 2017, following an initial scoping and feasibility phase, provide a report including refined evaluation proposals, detail on the engagement with the IPC areas to date, and any early findings.
Provide further interim reports on an annual basis, in a format to be agreed with the DH Liaison Officer, and including an accessible executive summary and appropriate caveats. This will include an interim report on early findings in Autumn 2017.
Provide brief update reports on a quarterly basis, summarising progress and highlighting any issues relating to the conduct of the evaluation, as well as any emerging findings and early learning
Provide a final evaluation report in Autumn 2018, as appropriate.
107. The detailed timing, format and handling of all research outputs will be for discussion and agreement with the DH Liaison Officer. It is expected that some or all of the
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evaluation interim reports, as well as the final report, will be published following satisfactory peer review.
Evaluation Team 108. The successful team is likely to include a range of experience and expertise for example in:
Programme evaluation, including robust impact assessment – Essential. Economic evaluation, including market impacts - Essential. Research on personal commissioning models in the health, social care or education sectors – Desirable. Research on integrated delivery across service boundaries, for vulnerable population groups – Desirable. Research on health and care inequalities / equity - Desirable. Social policy research on health and care services reform - Desirable.
109. Organisations may submit consortium bids to ensure teams have appropriate skills and experience.
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GENERAL INFORMATION FOR APPLICANTS 110. The Policy Research Programme (PRP) is a national programme of research dedicated to providing an evidence base for policy-making in the Department of Health (DH) and its arm’s length body (ALB) partners. It provides information to the Secretary of State for Health and his Ministers directly and through policy directorates in the Department, as well as to ALBs, and covers all aspects of the Department’s policymaking activity. 111. Applications will be considered from other UK countries provided they address the priority areas in a way that is relevant to the needs of the Department of Health (England) and meet all other selection criteria.
112. Applicants are encouraged to submit multidisciplinary applications. Governance Issues 113. Day-to-day management of this research will be provided by the principal investigator. They and their employers should ensure that they identify, and are able to discharge effectively, their respective responsibilities under the Department of Health Research Governance Framework for Health and Social Care22, which sets out the broad principles of good research governance. 114. All successful research involving National Health Service (NHS) and adult social care users, carers, staff, data and/or premises must be approved by the appropriate research ethics committee (REC) or social care research ethics committee (SCREC). For further information on RECs, please visit the National Research Ethics Service website: http://www.nres.nhs.uk/. 115. The successful research team must adhere to the Data Protection Act (1998) and the Freedom of Information Act (2000). Effective security management, and ensuring personal information and assessment data are kept secure, will be essential. In particular:
The research team shall, at all times, be responsible for ensuring that data (including data in any electronic format) are stored securely. The research team shall take appropriate measures to ensure the security of such data, and guard against unauthorised access thereto, disclosure thereof, or loss or destruction while in its custody.
Personal data shall not be made available to anyone other than those employed directly on the project by the research team, to the extent that they need access to such information for the performance of their duties.
22
Department of Health (2005): Research governance framework for health and social care [Online]. 2nd Ed. London: HMSO; 2005 [cited 2008 March 26]; www.dh.gov.uk/en/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/DH_4108962
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Risk Management 116. Applicants should submit, as part of their application, a summary explaining what they believe will be the key risks to delivering their research, and what contingencies they will put in place to deal with them. Please ensure this is detailed in the Management and Governance section of the online application form. 117. A risk is defined as any factor which may delay, disrupt or prevent the full achievement of a project objective. All risks should be identified. The summary should include an assessment of each risk, together with a rating of the risks likelihood and its impact on a project objective (using a high, medium or low classification for both). The risk assessment should also identify appropriate actions that would reduce or eliminate each risk, or its impact. 118. Typical areas of risk for an evaluation study might include ethical approval, site variation in data gathering, staffing, resource constraints, technical constraints, data access and quality, timing, management and operational issues; however, please note this is not an exhaustive list. Patient and Public Involvement (PPI) 119. The Policy Research Programme expects the active involvement of patients and the public (e.g. service users and carers) in the research that it supports where appropriate. However, it is accepted that the nature and extent of patient and public involvement (PPI) is likely to vary depending on the context of the study. Applicants should describe how the issue of PPI will be addressed throughout the research process. For example, this could include patient and public involvement in refining research questions, designing research instruments, advising on approaches to recruitment, assisting in the collection and analysis of data, participation or chairing advisory and steering groups, and in the dissemination of research findings. 120. Applicants are required to describe what active involvement is planned, how it will benefit the research and the rationale for their approach. 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. In addition, applicants should ensure that a budget line for the costs of PPI is included in the finance form. Where no PPI is proposed, a rationale for this decision must be given. 121. For further information and guidance about PPI, please visit the INVOLVE website: http://www.invo.org.uk/. Outputs and Reporting Arrangements 122. The research team will be expected to submit written progress reports over the lifetime of the research and will be provided with a standard template to complete at regular quarterly intervals, with occasional ad hoc reports in between. In addition to describing progress, these reports will allow researchers to indicate any significant changes to the agreed protocol, as well as setting down milestones for the next reporting period, giving an update on PPI and also any publications or other outputs. Information on 26
emergent findings that can feed more immediately into policy development will be encouraged and should be made available as appropriate. 123. A final report on the research, with an accessible executive summary, will be required within one month following completion of the research. The report will be peer reviewed and circulated to policy-makers in the Department of Health. Once your study is complete, a summary of your final report will be placed in the public domain, on the Department of Health Policy Research Programme Central Commissioning Facility (CCF) website. This is where the outputs resulting from expenditure of public funds are made available for public scrutiny so it is important that the summary of your final report is easily accessible to the lay reader.
124. Research contractors are obliged to give at least 28 days notice before submission of any publication arising from research funded by the Department of Health Policy Research Programme. In this instance, ‘publication’ concerns any presentation, paper, press release, report or other output for public dissemination arising from a research project funded by the PRP. There is no time limit to this provision and research contractors remain under an obligation to provide notice even after the contract has ended. Publication of PRP-commissioned research is subject to prior consent of the Secretary of State, which will not be held unreasonably and cannot be withheld for more than three months from the time the publication is submitted.
125. Research contractors will be expected to work with nominated officials in DH and partner government departments. Key documents including for example research protocols, research instruments and reports must be provided to DH in draft form allowing sufficient time for review. 126. Research contractors will be expected to, as appropriate:
Provide brief summary feedback for individual IPC areas at interim and final reporting stages
Present and discuss interim and final findings with the relevant policy Programme Board and / or Steering Group
Attend briefing meetings, and networking events for IPC areas
127. The evaluation team will be required to produce the following outputs / reports:
In April 2017, following an initial scoping and feasibility phase, provide a report including refined evaluation proposals, detail on the engagement with the IPC areas to date, and any early findings.
Provide further interim reports on an annual basis, in a format to be agreed with the DH Liaison Officer, and including an accessible executive summary and appropriate caveats. This will include an interim report on early findings in Autumn 2017.
Provide brief update reports on a quarterly basis, summarising progress and highlighting any issues relating to the conduct of the evaluation, as well as any emerging findings and early learning
Provide a final report in Autumn 2018, as appropriate.
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128. The detailed timing, format and handling of all research outputs will be for discussion and agreement with the DH Liaison Officer. It is expected that some or all of the evaluation interim reports, as well as the final report, will be published following satisfactory peer review. Dissemination 129. Applicants should describe how the research findings could be disseminated most effectively, ensuring that results of this research impact on policy and practice in the NHS, DH and system partner organisations. 130. Publication of scientifically robust research results is encouraged. This could include plans to submit papers to peer reviewed journals, national and regional conferences aimed at service providers, professional bodies and professional leaders. It might also include distribution of executive summaries and newsletters. Less traditional dissemination routes are also welcomed for consideration. Time Scale and Budget 131. The evaluation will be conducted within a period of 24 months (two years), starting in Autumn 2016. 132. Following a preliminary scoping and feasibility phase, an initial report including refined proposals for evaluation of outcomes will be required in April 2017. Release of funding beyond a 15 month break point in the contract will be conditional on satisfactory assessment and peer review of this scoping and feasibility report.
133. The Department of Health expects the evaluation to be delivered within a budget of up to £800,000 (eight hundred thousand pounds), including full economic costing as appropriate, but excluding output VAT. We will be looking for value for money and justified costing when considering full applications.
134. The duration of the proposed study should be as short as is consistent with a high quality study. 135. Funding to the level above will only be available if there are suitable high quality and relevant studies. 136. Notification of outcome is expected to be given by 23 August 2016. The successful evaluation team will be expected to start in Autumn 2016. Transparency 137. In line with the government’s transparency agenda, any contract resulting from this tender may be published in its entirety to the general public. Further information on the transparency agenda is at: https://www.gov.uk/government/publications/procurementand-contracting-transparency-requirements-guidance.
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138. If you wish to view the standard terms and conditions of the Policy Research Programme contract, please go to: www.prp-ccf.org.uk. Application Process 139. To access the research specification and application form, please visit the Policy Research Programme Central Commissioning Facility (PRP CCF) website at www.prpccf.org.uk. 140. The PRP CCF runs an online application process and all applications must be submitted electronically. No applications will be accepted that are submitted by any means other than the online process. Deadlines for the submission of research applications occur at 1.00 pm on the day indicated and no applications can be accepted after this deadline. We strongly recommend that you submit your application on the day before. 141. Once the 1.00 pm deadline passes, the system shuts down automatically and CCF Programme Managers are unable to re-open it. If you are experiencing any technical difficulties submitting your application, please contact the CCF on 0208 843 8027 in good time, before 1.00 pm on a closing date. 142. Applicants are expected, before submitting applications, to have discussed their applications with their own and any other body whose co-operation will be required in conducting the research. At stage 2, the declarations and signatures page must be printed off and signed by an administrative or finance officer for the host (contracting) institution to confirm that the financial details of the application are correct and that the host institution agrees to administer the award if made. This is the only part of the form required in hard copy. 143. The hard copy of the declaration and signatures page should be submitted within one week of the closing date to: PRP Commissioning Round 15 Integrated Personal Commissioning PRP CCF Grange House 15 Church Street Twickenham Middlesex TW1 3NL 144. The standard PRP application process: Stage 1: Outline Application Submission
Preliminary Sift
Stage 2: Full Application Submission
Peer Review
Commissioning Panel recommendations
Notification of Outcome
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145. In standard two stage commissioning, outline applications will be short-listed by a Commissioning Panel. Incomplete applications, applications too remote from the issues set out in the research specification, or applications that have clearly inadequate presentation or methods may be rejected at this stage. 146. Applications that are successfully short-listed by the Commissioning Panel will proceed to stage 2 of the application process and will be invited to submit a stage 2 full application for consideration. All full applications submitted to the PRP will be peerreviewed by both stakeholder and independent academic referees. Wherever time permits, applicants will be given one week to respond to the peer reviewers’ comments. 147. Full applications, peer reviewers’ comments and any responses to those comments will then be considered by the Commissioning Panel, which is comprised of independent experts (possibly with observers from other government departments and executive agencies), who will advise the Department of Health on which applications are most suited to receive funding. The Panel will be informed by the reviewers’ comments and any responses made to these comments by the researchers. However, it is ultimately the responsibility of the Panel to make any funding recommendations to the Department of Health. Selection Criteria 148. Criteria used by peer reviewers and members of the Commissioning Panel to assess applications for funding from the PRP include:
RELEVANCE of the proposed research to the research specification QUALITY of the research design QUALITY of the work plan and proposed management arrangements STRENGTH of the research team IMPACT of the proposed work VALUE for money (justification of the proposed costs) INVOLVEMENT of patients and the public
Timetable 149. It is anticipated that commissioning of this research will occur to the following approximate timetable:
Issue of invitation to tender: 26 January 2016 Deadline for receipt of stage 1 applications: 1 March 2016 Notification of outcome of stage 1: 3 May 2016 Deadline for receipt of stage 2 application: 1.00 p.m. on 7 June 2016 Peer review to be completed: 17 June 2016 Notification of outcome of stage 2: 23 August 2016 Award of contract: September 2016 (subject to pre-contract negotiations)
150. In order to maximise the benefit from the findings, the research will need to commence in Autumn 2016, following selection of the successful bid and placing of a contract.
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Contacts 151. General enquiries regarding the application and commissioning process can be directed to the PRP CCF Help Desk by telephone at 0208 843 8027 or by email to
[email protected]
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References and Key Documents Cabinet Office (2003): Trying it Out: The Role of ‘Pilots’ in Policy-Making. http://www.civilservice.gov.uk/Assets/Trying%20it%20Out_tcm6-36824.pdf Department of Health (2005): Research governance framework for health and social care [Online]. 2nd Ed. London: HMSO; 2005 [cited 2008 March 26] www.dh.gov.uk/en/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/D H_4108962 Department of Health (2013): Letter Inviting Expressions of Interest for Health and Social Care Integration ‘Pioneers’ (May 2013) https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/198746/201305-13_Pioneers_Expression_of_Interest_FINAL.pdf Department of Health (2013): Press release on integration Pioneers, 1 November 2013. https://www.gov.uk/government/news/integration-pioneers-leading-the-way-for-health-andcare-reform--2 Department of Health and NHS England (2014): ‘Transforming Primary Care: Safe, proactive, personalised care for those who need it most’, April 2014. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304139/Transf orming_primary_care.pdf Department for Health (2015): The Government’s Mandate to NHS England for 2016-17. https://www.gov.uk/government/publications/nhs-mandate-2016-to-2017 Forder J et al (2012): Evaluation of the personal health budget pilot programme, Personal Social Services Research Unit Discussion Paper 2840_2, November 2012. https://www.phbe.org.uk/ Glasby J and Littlechild R ((2009): Direct payments and personal budgets: putting personalisation into practice, Policy Press, May 2009. Glendinning C et al (2008): Evaluation of the individual budgets pilot programme – final report, Social Policy Research Unit, University of York, 2008. http://php.york.ac.uk/inst/spru/research/summs/ibsen.php Graham C, Killpack C, Raleigh V, Redding D, Thorlby R, Walsh J (2013): Options appraisal on the measurement of people’s experience of integrated care, Picker Institute Europe, March 2013. http://www.pickereurope.org/assets/content/pdf/Project_Reports/P2636_Integrated%20care %20report_post%20final%20edits_v7%200.pdf HM Government (2012): Caring for our future: reforming care and support, July 2012. http://www.dh.gov.uk/health/2012/07/careandsupportwhitepaper/ HM Government (2014): Care Act 2014, 14 May 2014. http://www.legislation.gov.uk/ukpga/2014/23/contents/enacted/data.htm HM Government (2014): Children and Families Act, 13 March 2014. http://www.legislation.gov.uk/ukpga/2014/6/contents/enacted
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King J, Gibbons E, Graham C, Walsh J (2013): Developing measures of people’s selfreported experiences of integrated care, Picker Institute Europe, October 2013. http://www.pickereurope.org/assets/content/pdf/News%20releases/Developing%20measure s%20of%20IC%20report_final_07012014.pdf Medical Research Council (2000): A framework for development and evaluation of RCTs for complex interventions to improve health, 2000. Medical Research Council (1998): Guidelines for good clinical practice in clinical trials, 1998. National Collaboration for Integrated Care and Support, Integrated Care and Support: Our Shared Commitment, May 2013. https://www.gov.uk/government/publications/integrated-care NHS England (2013): Everyone Counts: Planning Patients 2014/15 – 2018/19, December 2013. See in particular Annex I on Better Care Fund Measures and Information http://www.england.nhs.uk/wp-content/uploads/2013/12/5yr-strat-plann-guid.pdf NHS England (2014): Integrated Personal Commissioning Prospectus: making a reality of health and social care integration for individuals https://www.england.nhs.uk/wp-content/uploads/2014/09/ipc-prospectus-updated.pdf NHS England (2014): NHS Five Year Forward View http://www.england.nhs.uk/ourwork/futurenhs/ NHS England et al (2015): Delivering the Forward View: NHS Planning Guidance for 2016/17-2020/21 https://www.england.nhs.uk/wp-content/uploads/2015/12/planning-guid-16-17-20-21.pdf NHS England (unpublished): Integrated Personal Commissioning: Road Map for Delivery NHS England (unpublished): Integrated Personal Commissioning Programme Local Evaluation Strategy, March 2016. NHS Responsibilities and Standing Rules (Amendment) regulations 2013 http://www.legislation.gov.uk/uksi/2013/2891/pdfs/uksi_20132891_en.pdf Raleigh V, Bardsley M, Smith P, Wistow G, Wittenberg R, Erens B and Mays N (2014): Integrated care and support Pioneers: Indicators for measuring the quality of integrated care, Policy Innovation Research Unit, April 2014. http://www.piru.ac.uk/assets/files/IC%20and%20support%20Pioneers-Indicators.pdf RAND Europe, Ernst & Young LLP (2013): National Evaluation of the Department of Health’s Integrated Care Pilots, March 2013 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215103/dh_13 3127.pdf RAND Europe (unpublished): Future Evaluation of the Integrated Personal Commissioning Programme: mapping the logic and assessing evaluability. Confidential report to NHS England, October 2015. Think Local Act Personal (2014): Getting serious about personalisation in the NHS http://www.thinklocalactpersonal.org.uk/nl/?l=790_1_1_1
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ANNEX A Integrated Care and Support Policy and Legislative Context ‘Integrated Care and Support: Our Shared Commitment’ In May 2013, the Department of Health and other national leaders of health and care issued ‘Integrated Care and Support: Our Shared Commitment’.23 This highlighted a need to create – at scale and pace – a culture of co-operation and co-ordination between health, social care, public health, other local services and the third sector, supported by new technology and shared information, in order to provide a seamless service focused on the individual within their own home. The document set out how local areas can use existing structures like Health and Wellbeing Boards to bring together local authorities, clinical commissioning groups, NHS and social care providers, housing services, public health and others to make further steps towards integration. It heralded national leaders and local areas working closely together to deliver: a) an ambition to make joined-up and co-ordinated health and care the norm b) the first-ever agreed definition of what people say good integrated care and support looks and feels like, developed by National Voices c) new ‘pioneer’ areas around the country d) new measures of people’s experience of joined-up care and support The National Collaboration on Integrated Care and Support signed up to a series of shared commitments on how they will help local areas integrate services. The shared commitments (including expectations of action at local level) focused on: pursuing a common goal, providing national resources for local ambitions, providing practical tools to localities, integrating information, and accelerating learning across the system. In particular, there was a shared commitment by national partners to support new pioneer areas: “For the most ambitious and visionary localities, we commit to providing additional bespoke support and constructive challenge. This will be from a range of national and international experts to help pioneers realise their aspirations on integrated care and support and accelerate learning across the system. We aim to stimulate and support successive cohorts of pioneers and, in return, expect them to help rapidly share their accelerated learning across the system for the benefit of all localities.”24 In November 2013, following a selection process, DH announced a five- to seven-year programme of Integrated Care and Support Pioneers in 14 local areas (out of over 100 local areas that had expressed interest) in order to test the processes and outcomes of 23
National Collaboration for Integrated Care and Support (2013): Integrated Care and Support: Our Shared Commitment, May 2013. 24 National Collaboration for Integrated Care and Support (2013): Integrated Care and Support: Our Shared Commitment, May 2013, p.8
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innovative models of integrated care provision. The Pioneers programme was formally launched by the Minister of State for Care and Support, Norman Lamb MP, on 1 November 2013.25 Better Care Fund In June 2013, as part of the Spending Round 2013, a £3.8 billion pooled fund was announced to promote joint working between health and social care services in England. The Better Care Fund (BCF) provides for £3.8 billion worth of funding in 2015/16 to be spent locally on health and care through pooled budget arrangements to drive closer integration and improve outcomes for patients and service users and carers.26 Local Authorities and Clinical Commissioning Groups are required to work together, as part of existing planning arrangements, to produce and implement joint plans for use of BCF monies. The local plans are required to show how BCF funding will be used to meet the current six national conditions for funding access:
Seven day health and care services – to ensure that people can access the care they need when they need it. Data sharing, including the use of digital care plans and the NHS number – so that people don’t need to endlessly repeat their story to every professional who cares for them; and so that professionals can spend less time filling out paperwork and more time caring for patients. Joint assessments – so that services can work together to assess and meet people’s holistic needs. An accountable professional – who can join up services around individuals, and prevent them from falling through the gaps. Protecting social care – ensuring people can still access the services they need. Agreed impact on the acute care sector – to prevent people reaching crisis point, and reduce the pressures on A&E.
Furthermore, it was indicated in the Spending Round 2013 that £1 billion of the £3.8 billion Fund would be linked to achieving outcomes. Ministers have agreed that this payment for performance element of the Fund will operate using a mixture of national metrics, local metrics and progress against the national conditions. The five national metrics that are currently set to be used are:
Emergency admissions (Quarterly)
Delayed transfers of care (Monthly)
Effectiveness of reablement (Annually)
Admissions to residential care (Annually)
Patient/user experience (Annually)
25
Department of Health press release, 1 November 2013 https://www.gov.uk/government/news/integration-pioneers-leading-the-way-for-health-and-care-reform--2 26 In April 2014, the Minister for Care and Support, Norman Lamb MP, announced that the size of the Fund had increased to £5 billion, reflecting additional contributions pledged by health and local authorities.
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‘Transforming Primary Care’ In April 2014, the Department of Health and NHS England jointly issued “Transforming Primary Care: Safe, proactive, personalised care for those who need it most”.27 This document set out the actions being taken toward the vision of personalised, proactive care for those living with complex health and care needs. As such, it forms a relevant and important policy backdrop to the proposed evaluation of the IPC programme in the context of new funding arrangements for integrated care.
These steps include the following:
From September 2014, GPs will implement a proactive and personalised programme of care and support tailored to the needs and view of people with the most complex needs – the Proactive Care Programme By end June 2014, all people aged 75 and over will have a named GP with overall responsibility for and oversight of their care Improvements in communication between GP practices and other services, including A&E, community nursing services, ambulance services, care homes, mental health and social care team will support co-ordination of service around the patient Improvements in information and technology will support people to take more control of their own care Greater support and information will be given to people caring for family or friends, both to help them care for others and to support their own health and wellbeing Health Education England will work with employers, professional bodies and education providers to ensure the workforce has the necessary skills to care for older people and those with complex needs and to support joint working Joint working will be further supported by moving away from traditional professional boundaries, and improved information sharing Clinical commissioning groups will provide £250 million to commission services to support GPs to improve quality of care for older people and people with the most complex needs. During 2014, local pilots will be exploring new ways to improve access to GP services, supported by a £50 million Challenge Fund GPs will be expected to securely share records with other services where patients are content for them to do so Plans will be set in place to make available around 10,000 primary and community health and care professionals by 2020, in support of the shift in how care will be provided
Care Act 2014 On 14 May 2014, the Care Bill received Royal Assent and became the Care Act 2014. The Care Act 2014 includes provisions that are intended to put people and their carers in control of their care and support.
27
Department of Health and NHS England (2014): Transforming Primary Care: Safe, proactive, personalised care for those who need it most, April 2014 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304139/Transforming_primary_car e.pdf
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In relation to integration, the Care Act 2014 introduces a new duty for local authorities to promote the integration of care and support with health services and health-related provision such as housing services, where it considers that this would: a) promote the well-being of adults with needs for care and support, and the well-being of carers, b) contribute to the prevention or delay of needs for care and support in adults, and needs for support in carers, or c) improve the quality of care and support for adults, and of support for carers, provided in its area.28 The Act also establishes the legal framework for the Better Care Fund.
In addition, the Care Act 2014 introduces a new duty for authorities to consider physical, mental and emotional wellbeing in all decisions regarding an individual’s care needs, and assessments must consider the whole family. Local authorities will have to guarantee preventative services which could help reduce or delay the development of care and support needs. The Act provides and legislates for Personal Budgets to give people the power to spend money on tailored care that suits their individual needs as part of their support plan. The Act directs councils to provide advice and information, continuity of care and interprofessional working. It puts safeguarding on a statutory footing for the first time, and extends the role of advocacy. It also introduces a minimum eligibility threshold across the country – a set of criteria that makes it clear when local authorities will have to provide support to people.
28
This new local authority responsibility reflects a similar duty on NHS England and clinical commissioning groups to promote integrated care.
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ANNEX B Integrated personal commissioning policy – outline description by NHS England Integrated Personal Commissioning (IPC) is one of the key pillars of the NHS Five Year Forward View. It empowers people and communities to take an active role in their health and wellbeing with greater choice and control over the care they need. It supports the improvement, integration and personalisation of services. IPC Demonstrator sites are developing a new model of care for people with complex needs that will be rolled out across England by 2020-21. Better integration between health and social care is a firm priority to address fragmentation between services and improve people’s experience of care. Other approaches to integration focus at the system, organisational or functional level, ignoring the potential for people and communities to be integrators of their own health and care. The IPC model addresses this, providing practical solutions to integration at the level of each individual.
IPC is leading development of an integrated model for personalised care for people with complex needs, including: a. Children and young people with complex needs b. People with long term conditions who have complex needs c. People with learning disabilities with high support needs d. People with significant mental health needs IPC is a partnership between NHS England and the Local Government Association which builds on the success of personal budgets in social care and personal health budgets. Key policy points leading up to the announcement of IPC include:
Direct payments in social care were introduced in the mid 1990s with uptake limited until the piloting of personal budgets in 2005-2007
Personal budgets are now a mainstream option for delivery of social care, with around 500,000 people in receipt of long term social care currently with personal budgets.
The Care Act 2014 and Children and Families Act 2014 confirm personal budgets in law for everyone eligible for social care and as an option for children with special educational needs.
People who receive NHS Continuing Healthcare have the right to have a personal health budget since September 2014. Implementation is at an early stage and numbers are currently relatively low, in the first 6 months of 2015/16 around 4700 people received a personal health budget.
IPC was announced by NHS England Chief Executive Simon Stevens in July 2014 and is featured in the NHS Five Year Forward View published in September 2014.
The IPC programme was launched in October 2014 with a call for expressions of interest from health and care organisations to join the programme.
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Nine sites were selected to become demonstrator sites and the programme began in April 2015, the first year being a start-up phase.
The Mandate 2020 and the Planning Guidance for 2016/17 published in December 2015, committed CCGs to leading a major expansion in personal health budgets and integrated budgets. It is anticipated that 1-2 per 1000 of population (circa 50-100,000 individuals) could benefit from a PHB by 2020.
The Emerging Framework is due to be published in May 2016.
The last 18 months have seen a number of national programmes launched that are transforming the health and social care system dramatically. These include the New Models of Care Vanguards programme, the Better Care Fund, further devolution and the cocommissioning of primary medical services, as well as IPC and the expansion of personal health budgets. Empowering people and communities through personalisation and choice are essential components of the vision that these programmes are bringing to reality. We believe the commissioning that underpins the health and social care system in 2020 will be characterised as much by the ability to personalise and shape care and support in response to individual needs and preferences as by place based approaches and new models of care.
In future, IPC and personal health budgets will provide an essential counterbalance to the inherent monopoly of capitated provider models. Working alongside population based models of care, they will enable people who need a more personalised approach to opt out of their local provider and take charge of decision making around their care. IPC demonstrator areas are required to deliver the top end of the Mandate commitment regarding personal health budgets by 2018, two years more quickly than the rest of the system.
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ANNEX C Outline Description of Integrated Personal Commissioning Demonstrator Sites / Initiatives In April 2015, following a rigorous short listing and interview process, nine IPC demonstrator sites were selected. According to NHSE’s website, “Each demonstrator site is working with one or more of the following cohorts of individuals, who typically have high levels of need which often span both health and social care:
Children and young people with complex needs, including those eligible for education, health and care plans. People with multiple long-term conditions, particularly older people with frailty. People with learning disabilities with high support needs, including those who are in institutional settings or at risk of being placed in these settings. People with significant mental health needs, such as those eligible for the Care Programme Approach (CPA), or those who use high levels of unplanned care.
IPC is networked model of care, delivered through enhanced multi-disciplinary teams which draw together generalist, social, mental and specialist care with the voluntary sector into “IPC hubs”, usually located in general practice. The IPC model is characterised by 5 key shifts in people’s experience of care, brought about through the adoption of specific service components. Together these components drive improved outcomes for people, the system and the tax payer, delivering better quality of life, reductions in unplanned care and enhanced experience of health and care services.” The nine IPC demonstrator sites are as follows: 1. 2. 3. 4. 5. 6. 7. 8. 9.
Barnsley Cheshire West and Chester Hampshire: My Life, My Way Lincolnshire Luton Portsmouth South West consortium Stockton-on-Tees: My Voice, My Choice Tower Hamlets
Press releases relating to each IPC site can be accessed via the following NHSE weblink: https://www.england.nhs.uk/commissioning/ipc/ Further information about the IPC programme can be accessed via the following links:
TLAP have produced an easy read document to explain more about IPC: TLAP website. NHS England IPC Prospectus press release NHS England IPC press release
Further information about the nine IPC demonstrator sites is expected to made available via an interim report on PIRU’s / EHCRU’s scoping and early evaluation study.
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Details of the Nine IPC Demonstrator Sites
Projected uptake – March 2018 (draft) Name of site
Partners
Barnsley
NHS Barnsley CCG Barnsley Metropolitan Borough Council DIAL Barnsley South West Yorkshire Partnership NHS Foundation Trust Barnsley Hospital NHS Foundation Trust Cheshire West and Chester Council West Cheshire CCG Vale Royal CCG Hampshire County Council Adults and Children’s Services Five Hampshire Clinical Commissioning Groups Hampshire Advocacy Regional Group (HARG) Independent Lives
Lincolnshire County Council NHS Lincolnshire West CCG South Lincolnshire CCG
Cheshire West & Chester
Hampshire My Life, My Way
Lincolnshire
IPC cohort
Care plans
Personal budgets (including NHS funding)
People with diabetes, respiratory problems, and COPD (chronic obstructive pulmonary disease)
4,624
2312
462
People with learning disabilities and/or autism
6,640
3,320
664
Not provided
2,000
900
7,938
1,041
Initial cohorts
People aged 14 year and over with a physical disability, learning disability or autism
People with learning disabilities, dementia, severe mental health
1,028
Luton
Portsmouth
Lincolnshire East CCG South West Lincolnshire CCG Voluntary sector partners
Luton CCG Luton Borough Council The Disability Resource Centre Age Concern The Alzheimer’s Society East London NHS Foundation Trust Memory Assessment Services Portsmouth City Council NHS Portsmouth CCG Solent NHS Trust Age UK Living Well project
South West consortium29
11 CCGs across the South West 13 local authorities Health Education England (South West) Academic and Health Science Network South West Strategic Clinical Network South, Central and West Commissioning Support Unit Range of voluntary and community sector organisations
problems and children transitioning to adult services
People diagnosed with dementia
3,586
1350
500
People over the age of 50, with two or more long-term conditions, who have been hospitalised at least twice in a 12 month period.
4,373
2,187
437
Children with complex needs and their families People with severe learning disabilities People with multiple long term conditions, including older people living with frailty
Not available
Not available
Not available
People with significant mental health needs
29
Please note – the status of the SW’s involvement in the programme from 2016-17 onwards is currently being agreed. It is likely that the region, which is taking a different approach to IPC implementation, may not be included within the scope of the evaluation in the same way as other areas.
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Stockton-on-Tees My Voice, My Choice
Catalyst Stockton Hartlepool & Stockton-on-Tees CCG North Tees and Hartlepool NHS Foundation Trust Stockton Borough Council
Older adults with long term respiratory conditions
4,000
2,000
400
59,917
3,992
605
People with social care needs and one or more of the following:
Tower Hamlets
NHS Tower Hamlets CCG Tower Hamlets Council Real Bromley by Bow Centre
Adults with learning disabilities Adults with severe and enduring mental illness Adults with multiple long term conditions Children with statement of educational needs (SEN).
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