20/04/23

NIHR Health Services & Delivery Research

(HS&DR) Programme

NETSCC: Established: 2008

Public Health Research

Established: 2008

Health Technology Assessment

Established: 1993

Health Services and Delivery Research

Established: 2012

NIHR Evaluation, Trials and Studies (NETS) programmes

Efficacy and Mechanism EvaluationResearcher-ledFunded by the MRCManaged by NIHRCommissionedFunded and managed by NIHREstablished: 2008 & 2011

NIHR Purpose and Remit

►The HS&DR programme funds research to improve the quality, effectiveness and accessibility of the NHS, including evaluations of how the NHS might improve delivery of services.

►The audience for this research is the public, service users, clinicians and managers.

►Annual budget around £20 million

►Three 2-day meetings per annum to allocate funding

Reviewing Grants – before the meeting

• Shortlisted grants are sent for external review – you can nominate reviewers and others will be chosen.

• 3 HSRC members are allocated to speak to each grant at the meeting and to pre-score on a 6 point scale (from “definitely fund” to “ reject”).

• NB in reality, the opinion of these 3 panel members is far more important than the 8 or so “expert” referees.

3 biggest surprises to me;

• NHS Managers

• Patient Public Involvement (PPI)

• Don’t worry about the money

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Reviewing Grants – at the meeting• The lead committee member speaker for each grant briefly summarises

the strengths and weaknesses, and recommends fund, resubmit or reject. The 2nd and 3rd speaker then do the same.

• The PPI assessor then speaks to the grant.

• The external reviewers’ comments are then read out.

• The grant is then open for discussion by the rest of the committee.

• All members are then asked to recommend fund, resubmit or reject, and to independently rate the scientific merit of the application on a 0-6 scale using an electronic “clicker”

What makes a good application?• “It would be interesting to look at….” = Reject

• You are not writing solely for peer review by colleagues in your discipline – you must be able to “sell your project” as important to health economists, psychiatrists, nurses, GPs, NHS managers and lay people.

• Simple is often good. Have clear, specific and achievable aims.

• Justify multiple measures – psychology applications can come across as complete fishing expeditions.

• Don’t use psycho-babel

• Clarify primary and secondary outcomes.

• Why should the tax payers’ money be risked on this project as opposed to others with clear health improving potential, e.g. RCT of intensive physiotherapy for elderly people following hip replacement?

• You want to test if optimism can predict 10% of the variance in quality of life in patients with arthritis – who gives a sh**?

What makes a good application (cont.)?

• What is the expertise and track-record of the research team?

• What is the evidence that the applicants will be able to deliver what they propose doing? – pilot study data presented?

• Many projects go down because the committee are not convinced the team will be able to deliver what they say they will do – provide evidence from a strong team with pilot data whenever possible re recruitment rates etc.

• A sloppy application does not inspire confidence – triple-check it, get others to check it and then triple-check it again.

• Abstract and lay summary are crucial – may be the only parts all of your application that all members read.

• Good idea to discuss proposal ideas at an early stage with CSO/NIHR staff – very helpful

What makes a good application (cont.)?

• A clearly written proposal that flows well, argues a compelling case, with a sound scientific basis, with a clear primary outcome, with a clear analysis plan, from an experienced multi-disciplinary team, on an important NHS topic, with pilot data, with costs fully justified, will stand a better chance.

• Don’t scrimp on cost – ask for the money you need to do an excellent project properly.

• Some grants go down because the board don’t believe the project can be done properly for the costs requested.

• Good idea to discuss proposal ideas at an early stage with CSO/NIHR staff – very helpful

Two important guidelines that come up repeatedly in interventions

• Revised MRC framework for complex interventions

• CONSORT criteria for interventions

Revised MRC framework for development and evaluation.

Peter Craig et al. BMJ 2008;337:bmj.a1655

©2008 by British Medical Journal Publishing Group

Example of CONSORT flowchart

Common Pitfalls 1

►Contradictory accounts of planned research ►Incorrect or inconsistent numbers e.g. sample size calculations ►Apparent lack of awareness of major or related work in train►Too many acronyms

Common Pitfalls 2

►Insufficient detail, or muddled detail particularly in the methodology sections►Gaps in expertise on the research team – e.g: health economist for cost effectiveness studies►Not enough detail on the health issue given ►Not enough detail on the intervention

Progress Reports• If you get the grant great! – BUT you now have to deliver what you

said you would do…..

• Regular progress reports must be submitted

• If the project does not progress well, e.g. poor recruitment, then funding can be (and is) stopped. This is very bad news…….

• Problems often occur – that is the nature of the applied research – the key is to communicate and keep the CSO/NIHR informed from an early stage– they want to help.

Final Reports• A formal final report must be submitted by the end date of the grant for CSO.

• This final report is important!

• They should provide a clear and succinct description of the work that has been conducted (key findings and their significance for policy and practice). It should enable the committee to judge the extent to which the original agreed objectives of the research have been met.

• Your application will be matched up against your final report

• An unsatisfactory final report can lead to a letter to the Principal of the University and the applicant being barred for applying for further funding. This happens……..

Dealing with Rejection

• NB Everybody gets rejections • Rejection feels lousy• It is usually a private and lonely experience and often leads to

ruminations about competence and self-worth• Vital to elicit social support and discuss it with colleagues• Get as much feedback from CSO/NIHR as possible• Once the wounds have started to heal (and the pins removed from

effigies of chosen HSRC members), begin to re-work the application, incorporating the useful criticism and resubmit elsewhere

• Those who are good at obtaining funding typically respond to rejection by revising and re-submitting the application elsewhere quickly.

Questions/Discussion?