Scaling Up Improvement

Scaling Up Improvement Call for Applications Round 3 April 2017 The Health Foundation Tel 020 7257 8000 www.health.org.uk Scaling Up Improvement 1

Contents 1. About the Health Foundation 3 2. Scaling Up Improvement at a glance 4 3. An overview of the programme 6 4. Benefits of participating 7 5. The Scaling Up Improvement programme in detail 7 5.1 Types of projects 7 5.2 The problem your project aims to address 7 5.3 The intervention or approach 8 5.4 Scale 9 5.5 Evaluation 10 5.7 Spread and wider adoption 12 5.8 Timescales 12 5.9 Budget 13 6. Which organisations can apply 14 6.1 Which organisations can apply as a lead organisation 14 6.2 Which organisation can apply as partner organisations 15 6.3 Skills and experience of applicants 15 7. Selection criteria and process 17 7.1 Selection criteria 17 7.2 How to apply 19 8. Working with successful projects 21 8.1 Support from the Health Foundation 21 8.2 Programme events 21 8.3 Project management and reporting 21 8.4 Communications 22 8.5 Intellectual property 22 Scaling Up Improvement Call for Applications round three 2

1. About the Health Foundation The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. Our aim is a healthier population, supported by high quality health care that can be equitably accessed. We learn what works to make people s lives healthier and improve the health care system. From giving grants to those working at the front line to carrying out research and policy analysis, we shine a light on how to make successful change happen. We make links between the knowledge we gain from working with those delivering health and health care and our research and analysis. Our aspiration is to create a virtuous circle, using what we know works on the ground to inform effective policymaking and vice versa. We believe good health and health care are key to a flourishing society. Through sharing what we learn, collaborating with others and building people s skills and knowledge, we aim to make a difference and contribute to a healthier population. For more information visit: www.health.org.uk Scaling Up Improvement Call for Applications round three 3

2. Scaling Up Improvement at a glance The Scaling Up Improvement programme: We will support up to seven projects that aim to scale and spread tested interventions or approaches to improve the delivery of healthcare services. Projects should result in direct benefits on patient outcomes within the programme timescale. Each project will receive up to 500,000 of funding to support the implementation and evaluation of the work. This funding can be supplemented by applicant organisations. The Health Foundation will provide successful project teams with tailored coaching support, access to improvement experts as appropriate and opportunities to connect with other project teams and networks. The funding for each project within this programme will run for up to two years, following a recommended six-month set-up phase. The implementation of each project is expected to begin by Tuesday 1 May 2018. Types of projects: Successful projects will be scaling interventions or approaches that have been tested and shown to be successful at small scale, ie through small scale improvement projects or through appropriate research evidence. These projects must be able to make improvements at scale at care pathway, health board, clinical network, organisational, regional or national levels, using a clearly identified improvement/adoption methodology. Applicants should demonstrate a clearly identified problem that they want to address that is a significant quality issue, widely relevant to UK health care. The chosen intervention or approach should be based on a logical rationale of why it will address the identified issue and result in improvements in health care. Applications must be able to provide robust evidence to demonstrate that ideas, interventions and approaches have already been tested and thoroughly evaluated to show that they are ready for adoption and spread. If it is being transferred from a different setting, a case will need to be made for feasibility in the proposed setting. Applications should include a clear description of the expected improvements, including how these will be delivered, assessed and measured. Applications will be expected to have a detailed measurement framework and plan in place, including key metrics and a description of existing baseline data. Independent rigorous evaluation is an essential component of this programme. Successful project teams will be responsible for commissioning a full and independent evaluation of their improvement work. Scaling Up Improvement Call for Applications round three 4

Applicants: Applications can come from any health or health and social care provider organisation in the UK where NHS services are free at the point of delivery. We also welcome applications from organisations with ability to reach and engage health care audiences and with capability to promote, spread and embed change across NHS through partnership working, such as CCGs, Health Boards, Patient Safety Collaboratives, Royal Colleges, AHSNs, and voluntary organisations (for a full list please see section 6).These organisations must partner with one or more NHS provider organisations and ensure that improvement takes place within the provider organisation(s). Applications should come from a partnership of organisations working together. Due to the range of skills and experience required to deliver an improvement project of this scale, we expect a lead organisation to work together with a number of organisations and be clear about their respective roles in the work. Applications should come from teams with a strong track record in change management, quality improvement methods, patient involvement, measurement and evaluation. Partnerships need to include an organisation that can influence wider practice and opinion. All applications must be made using the online application system (AIMS). Paper application forms will not be accepted. It is recommended that the online application process is started at least a week before the closing date as the applicants will need to include signatures from partners and / or senior project sponsors before being able to submit an application. Please note that the AIMS will be closed for maintenance on Monday 8 and Tuesday 9 May 2017 during which time you will not be able to access your application. Applicants should read this Call for Applications, FAQs and any guidance notes in the application form before submitting their application. These are available at: www.health.org.uk/scalingup The deadline for applications is 12 noon on Wednesday 17 May 2017. Scaling Up Improvement Call for Applications round three 5

3. An overview of the programme The Health Foundation has 3.5 million on offer to support up to seven project teams in Round three of the Scaling Up Improvement programme. Each project team will receive up to 500,000 in funding to design, implement and evaluate their project. The aims of this programme are to: Support demonstrable improvements in quality of care Scale up proven interventions or approaches Develop relationships between teams and national spread partners to support sustainability Build capacity and capability for learning of how to improve quality of care Contribute to the evidence base through robust measurement of improvement and evidence through independent evaluations. Scaling Up Improvement is our flagship programme supporting the scale and spread of tested interventions to improve the delivery of healthcare services. It enables teams to demonstrate their intervention at scale, and to generate evidence of its success through independent evaluation. We recognise that scale will have different implications depending on the focus of the project. By scale, we mean, for example, a care pathway, a health board, a clinical network or at organisational level. We believe that having a national or regional organisation partner generates traction for spread and aids sustainability of projects, maximising impact on both individual patient care and the system more broadly. Therefore all applications should involve an organisation such as a Royal College, an AHSN, a Health Board or a national charity as part of the partnership. Successful project teams will be responsible for commissioning a full independent evaluation of their improvement work. Evaluation is the best mechanism we have to demonstrate effectiveness at scale convincingly, and generate a detailed understanding of how, and why, this was (or was not) achieved. This programme will not support any untested innovative solutions to the problems in health care delivery or quality. New innovation projects are supported through the Health Foundation s Innovating for Improvement programme which will open for applications later in 2017. The Health Foundation is currently offering the opportunity to apply for consultancy support to explore social franchising as a spread method. The deadline for applications is 4pm on Thursday 13 April 2017. You can find out more at http://www.health.org.uk/socialfranchising Unsuccessful applications from previous Scaling Up Improvement rounds will not automatically be considered in this round and it is essential that organisations resubmit their applications using the online application system (AIMS) with the updated material. Paper application forms will not be accepted. Scaling Up Improvement Call for Applications round three 6

4. Benefits of participating The Scaling Up Improvement programme aims to make demonstrable improvements in the UK health care system, by supporting improvement projects with the potential for wider adoption. Participating organisations can expect to benefit in many ways, including: funding of up to 500,000 for each of the successful projects opportunities to be seen as leaders in health care improvement and to showcase work to a variety of key stakeholders protected time to implement an improvement project opportunities to tap into improvement expertise and tailored coaching support opportunities to deepen knowledge about evaluation of improvement interventions and the process of adoption and spread opportunities to connect with other project teams, to strengthen existing networks and develop new networks opportunities to inform the Health Foundation s agenda for influencing policy and practice nationally and internationally. 5. The Scaling Up Improvement programme in detail 5.1 Types of projects The Scaling Up Improvement programme will support up to seven projects. Projects should address an identified problem in health, or in health and social care. We are seeking applications from all sectors including primary, secondary or tertiary care, or across boundaries such as health and social care. This programme is specifically concerned with projects that: equip health care providers to improve the quality of care, by making improvements in services equip people to manage their conditions and health care more effectively will lead to direct benefits for patients within the programme timescale. This programme will not support projects targeted at: health promotion, screening and preventative activities (e.g. prevention of injury or illness) research into the causes and treatment of illnesses development of new or existing treatments, drugs or medical devices development of technical interventions such as (but not limited to) surgical techniques and procedures. 5.2 The problem your project aims to address Applications should provide evidence of a clearly identified problem which the project will address. This should be widely relevant to UK health care with the goal of generating generalisable learning. Given contextual differences, scaling one solution to multiple places Scaling Up Improvement Call for Applications round three 7

may not be appropriate and instead systematically supporting adopter sites to identify their own solutions may be more appropriate (through scaling an approach, methodology or by building capability for example). In either case the project must be able to demonstrate impact on patient outcomes within the timescales of the programme. Applications should describe the nature and severity of the problem that the project seeks to address. You might choose to reference the significance of the health issue, condition or disease for patients; the impact on mortality; impact of symptoms; and / or the impact on quality of life locally or nationally. Applications may draw on information such as population prevalence and incidence, cost to health services and to wider society, and alignment of priorities with key stakeholder organisations. 5.3 The intervention or approach Applications will need to demonstrate evidence of a logical link between the identified problem and the proposed intervention. The intervention or approach must have already been tested and been shown to be successful and be ready to be implemented at scale. If a specific intervention is being transferred from a different setting, a convincing case will need to be made for feasibility in the proposed setting. In this case, the context for the original intervention will need to be described, the conditions for success clearly identified and an explanation of how these conditions exist or will be created in the proposed setting. If an approach or methodology is being scaled in order to uncover context specific solutions you should include evidence about the efficacy of the proposed approach. The evidence base for the interventions could be from a local, national or international setting, and from research or practice. It could be from small scale improvement projects in the applicant s own organisation that has been shown to work, has resulted in improvements, and is now ready to be implemented at scale. It could also be from a small scale intervention conducted somewhere else or through appropriate research evidence. We are specifically looking to support ideas that have wider benefit and are likely to be generalisable and widely transferable across the health service. We would therefore expect to see a clear measurement framework and outline of expected benefits. We would also expect to see that earlier work has been published or presented beyond the local setting. The programme will not support projects using the following: Traditional research or laboratory-based activities. Education and training as a primary purpose or sole focus of the project (we will fund education and training as a supporting element of a project). Any development or capacity building which is unlikely to have a direct impact on patients within the lifetime of this programme. Development of technical or clinical interventions focused on clinical effectiveness such as (but not limited to) surgical techniques and procedures and drug administration techniques. Product or technology development as a primary purpose or focus of the project (we will fund improvements to services, processes and practices supported by IT solutions where applications can provide a convincing case that the technology development is not the primary purpose). Scaling Up Improvement Call for Applications round three 8

Below are examples of previous Scaling Up improvement awards. These are for illustration purposes only, and are not an indication of any preference by the Health Foundation. Improving prescribing safety in general practices in the East Midlands through the PINCER intervention is led by Lincolnshire Community Health Services NHS Trust. The use of a proven pharmacist-led information technology intervention for reducing medication errors, PINCER, has been shown to reduce rates of prescribing errors by up to 50%. This project involves rolling out PINCER in at least 150 general practices in the East Midlands. HIP QIP project is scaling up a successful hip fracture quality improvement project across five other acute hospital trusts who are currently struggling to provide safe, high quality hip fracture care to patients. The project is led by Northumbria Healthcare NHS Foundation Trust and involves a multidisciplinary audit framework, nutrition prioritising, a surgical care bundle and carrying out root cause analysis of any deaths. The project is being implemented in partnership with British Orthopaedic Association, AHSN for North East and Cumbria and RCP. Helping young people THRIVE: a person-centred model of care for young people s mental health is a project led by Tavistock and Portman NHS Foundation Trust which aims to scale up the THRIVE framework in four localities across North East London NHS Foundation Trust. THRIVE is a conceptual framework that enables delivery of care according to needs and preferences of children and young people. Expected improvements include better access to care, reduced waiting times, adherence to treatment and better patient experience. Sheffield Microsystems Coaching Academy, led by Sheffield Teaching Hospitals NHS Foundation Trust uses clinical microsystems methodology to help build improvement capacity into everyday frontline work. Frontline staff are trained as improvement coaches and work with teams through understanding their systems and processes, and redesigning care through testing small changes. The clinical microsystems methodology was developed in the USA by The Dartmouth Institute, one of the key partners in this project alongside Sheffield Health and Social Care NHS Foundation Trust, and Sheffield Children s NHS Foundation Trust. 5.4 Scale A key ambition of this programme is to generate and share evidence of best practice in health care improvement. This will require the applicants to demonstrate the intervention that will be delivered at scale over the course of the programme. We recognise that scale will have different implications depending on the focus of the project. By scale, we mean, for example, a care pathway, a health board, a clinical network or at organisational level. A large acute trust may be able to demonstrate scale through a trust-wide intervention such as an initiative to reduce patient falls, whereas a patient focused pathway intervention such as improved condition self-management may require the participation of a number of separate organisations. The rationale for the scale, including the number of patients and the number of NHS service provider organisations and partners to be involved in the project, will need to be addressed in the application. Scaling Up Improvement Call for Applications round three 9

5.5 Evaluation Robust independent evaluation is an essential component of this programme. Evaluation is the best mechanism we have to demonstrate effectiveness at scale convincingly, and generate a detailed understanding of how, and why, this was (or was not) achieved. Successful project teams will be responsible for delivering an independent evaluation of their improvement work, including an understanding of the levers and barriers to adoption and spread. The Health Foundation has developed a quick evaluation guide intended to assist those new to evaluation by suggesting methodological and practical considerations and providing resources to support further learning. The guide answers some of the commonly asked questions about how to approach evaluation of quality improvement in health care. Prospective applicants should read the guide when considering their application for this programme. 5.5.1 Evaluation team composition and expertise Organisations will be expected to work in partnership to deliver a project that implements improvements while carrying out a credible evaluation. We do not expect the lead organisation to possess the necessary expertise in evaluation. Instead, they will need to partner with or commission a team to carry out an independent evaluation of the intervention. This partnership will need to be in place at the application stage, and a named evaluation lead from the partner organisation should be provided. The lead organisation should have experience of working with evaluation providers and / or commissioning evaluations of improvement interventions. The evaluation partners should be close enough to the work of the project to help inform the design of the intervention by asking challenging questions and providing ongoing feedback to the implementation team. However they will also need to remain distant enough from the implementation team to be able to provide objectivity, and carry out an appropriate independent evaluation of the intervention. 5.5.2 Evaluation methodology By tasking project teams and their evaluation partners with designing and delivering their own evaluation, project teams are expected to deliver an evaluation that is appropriate to their specific improvement intervention and the context of their work. The Health Foundation is, therefore, not specifying the aims, evaluation questions and methodology that project teams should use for their evaluation, but expecting the applicants to provide this detail. When designing the evaluation it may be helpful for applicants to consider the balance between an evaluation designed to evidence impact at scale (likely to be quantitative), formative evaluation to help teams improve as the project progresses, process evaluation to understand what changes were introduced and why, and qualitative evaluation designed to understand the experience of the change. We would anticipate evaluations to have considered all of the above and to be able to make a clear argument for which elements they have chosen to prioritise in the evaluation design, bearing in mind that the aim is to contribute to the knowledge base around effectiveness of Scaling Up Improvement Call for Applications round three 10

the intervention at a larger scale and / or in different contexts and explaining how, and why, this impact was (or was not) achieved. Evaluations should consider whether the intervention is likely to be transferable to different contexts in the health care service, what constitutes the essential ingredients of the intervention and which elements may need to be adapted to different contexts. If interventions which were proven successful at a small scale appear not to be scalable, the evaluation should be able to demonstrate why this was the case. While we do not necessarily expect a full economic evaluation, applicants should capture the costs of the intervention and undertake some form of economic analysis. The evaluation should be consistent with best practice in evaluation, in order for the evaluation results to be credible. In particular, all evaluations are expected to undertake an evaluability assessment, sometimes called exploratory evaluation, as part of their evaluation work. 1 Our experience suggests that evaluability assessment forms a useful first step in evaluations of improvement interventions, supporting the refinement of the design of both the evaluation and the improvement work itself. Indeed, given its role in supporting evaluation and intervention design, applicants are expected to demonstrate elements of evaluability assessment in their applications. Should applicants think that evaluability assessment is not appropriate for particular circumstances, this will need to be justified fully in the application. Applications should show that their evaluators are fully cognisant of the Medical Research Council s (MRC) updated guidance on Developing and Evaluating Complex Interventions. 2 5.5.2 Research governance The application should demonstrate an appreciation of the ethical considerations of undertaking evaluation in the context of service development and should include plans to attain any necessary ethical approvals if required. Should the application be successful, the evaluation component of the project should be supported by an advisory group, established and facilitated by the project team. For applications requiring research and development, ethical approval must have been considered prior to the submission. The Health Foundation will require a confirmation that relevant approvals are either not necessary or will be sought according to an agreed timeline as part of the formal agreement process before funding will be released. Further advice about when research and development or ethical approval is required can be found by visiting the links below: 1 See for example Leviton et al. Evaluability Assessment to Improve Public Health Policies, Programs, and Practices. Annual Review of Public Health 2010;31:213 33. Available via http://www.annualreviews.org/eprint/3qapif4i2mnmg6rfsdfx/full/10.1146/annurev.publhealth.012809.103625 2 Craig et al. Developing and evaluating complex interventions: new guidance, Medical Research Council 2008. Available via http://www.mrc.ac.uk/utilities/documentrecord/index.htm?d=mrc004871 Scaling Up Improvement Call for Applications round three 11

http://www.hra.nhs.uk/research-community/before-you-apply/determine-which-reviewbody-approvals-are-required/ http://hra-decisiontools.org.uk/ethics 5.5.4 Expected outputs from the evaluation The evaluation should provide both an interim and a final report. The final report is intended for publication on the Health Foundation website 3 ; the interim report is not intended for publication. Evaluation findings should inform the final project report to the Health Foundation, but a final evaluation report deadline could be extended beyond the funding period if the intention is to capture post-project findings. Beyond this, the project teams will be free to agree appropriate reporting arrangements with their evaluation partners. The Health Foundation encourages publication, preferably in open access peer reviewed journals, to disseminate learning from the evaluation to a wider audience, and will be looking for evaluation partners to have a track record of publication and plans to publish related articles. 5.6 Spread and wider adoption Applicants will need to demonstrate the participation of a relevant influential organisation that can assist with the further dissemination of the intervention and increase the likelihood of wider impact. This may be a professional body, membership organisation, improvement network, clinical network, patient organisation or health related charity. This organisation s role may be as an active participant in the project or in an advisory role. At a minimum, it will be expected to have a role on the steering group of the project and to promote learning and insights to others. Some applications may benefit from involving more than one influencing organisation. In England this could be at a national or regional level. Applications based in Scotland, Wales or Northern Ireland may choose to work with a body that covers only their own nation or that has a UK-wide remit. 5.7 Timescales The programme has been designed with a set-up phase (to collect baseline data, gain research approvals if necessary and recruit a project manager) and up to two years for the implementation phase. The set-up phase, recommended for up to six months, is scheduled to begin in November 2017, once the formal agreements have been signed. Implementation should start by 1 May 2018 at the latest. 3 Publication will be at the discretion of the Health Foundation, but it is our usual practice to publish all work of sufficient quality and which is therefore of public benefit. Scaling Up Improvement Call for Applications round three 12

5.8 Budget The maximum funding a project application can request is 500,000 but we anticipate some projects may require less and these are equally welcome to apply. Applicants are expected to provide detailed budgetary information on the total cost of the project, what the funds will cover and details of any co-funding or matched funding. The following list outlines types of expenditure we would expect to fund. The list is not exhaustive, and we are aware specific projects may require other types of expenditure: Backfill costs for leadership and clinician time spent on the project. Honoraria for any patient / carer / service users involvement. Full time project management capacity for the duration of the funding period. Administrative support. Dedicated support and resources to rigorously test and evaluate the idea and produce a write-up of evidence and learning. Data collection and any associated cost relating to local processing, extraction and staff time to carry out analysis. Supply of technical expertise Attendance at meetings in relation to the project, including room hire, catering, etc if appropriate. Travel costs to attend up to five learning sessions hosted by the project teams (accommodation will be paid for by the Health Foundation). Backfill for staff (clinical and non-clinical) requiring training, involvement in project teams or implementing the changes, and attendance at the learning events. Communication materials and associated staff time required to promote the project and to take part in interviews / events related to the promoting the project. The evaluation budget should be ring fenced and fully itemised in the application. The budget for evaluation should be sufficient to deliver the type of evaluation described in the application. We recognise that different types of evaluation methodology require different levels of resource. We would expect the proportion to be in the region of 15% to 35% of the total budget and any deviation from this would need to be supported by a convincing justification. The Health Foundation will not fund the following items: Substantive clinical posts linked to specific intervention that will not be sustained after the funding period. Capital expenditure such as vehicles, buildings or refurbishments. Large items of equipment (over 2,000) including scanners, IT hardware, etc. Organisational overheads such as costs of premises, management and HR. The procurement of day-to-day consumables or of business-as-usual equipment. Scaling Up Improvement Call for Applications round three 13

6. Organisations that can apply 6.1 Organisations that can apply as a lead organisation The Scaling Up Improvement programme is open to applicants from across the UK. This programme is targeted at teams experienced in large scale complex improvement / change projects. We expect applicants will apply as a partnership of a number of organisations working together. Within this partnership, we expect one organisation to act as the lead applicant or lead organisation and the other organisations as partners. Lead organisations could include any of the following organisations: NHS providers Clinical Commissioning Groups* Sustainability and Transformation Plan Boards * Royal Colleges* Collaborations for Leadership in Applied Health Research and Care (CLAHRCs)* Charity and voluntary sector organisations* Academic Health Science Networks (AHSNs) including Patient Safety Collaboratives*** Health Boards* GP practices/federations Commissioning Support Units* Care homes. ** *If the lead organisation is not a NHS provider but an organisation providing leadership and support to the NHS providers, they must partner with the organisation(s) providing services free at point of delivery and ensure the improvement(s) takes place in that setting. **If the lead organisation is a non NHS provider of health services, the organisation must be commissioned, or in an authorised position, to provide these services through the appropriate channels across the UK (e.g. registered with the Care Quality Commission in England). These providers must be able to demonstrate that more than 50% of their work is with NHS-funded patients. ***In the case of AHSNs acting as a lead organisation, in addition to requirement to partner and support improvement within NHS organisation(s), we would require further reassurances that they will be able to provide continuity of services until the end of the programme (late 2020). Given the current process of re-licensing, we need to be convinced of their commitment and capacity to provide financial stability, leadership, governance and infrastructure for the project of this scale. A lead organisation must be legally constituted. It may be constituted as an NHS body, a not for profit organisation (e.g. a charity or a company limited by guarantee), a social enterprise, a company limited by shares or a community interest organisation. If the constitution allows the lead organisation to make a profit, the Health Foundation would have to be convinced that it is not supporting private profit making companies delivering only a small benefit to the NHS. Where a not for profit organisation has another arm that is profit making, the Health Scaling Up Improvement Call for Applications round three 14

Foundation would need to be convinced that our funding is going to the nonprofit making arm. We will not accept applications from organisations based outside of the UK, individuals or sole traders. The Health Foundation requires a lead organisation to ensure that there is appropriate influence and governance over the project, including the implementation of the intervention, engagement of clinical and non-clinical staff, management of the project and the funding provided by the Health Foundation. The Health Foundation will contract with the lead organisation. The lead organisation will be responsible for creating and monitoring any arrangements with its partner organisations. We strongly recommend that lead organisations are only involved in one application. We are seeking to support a diverse range of projects so are very unlikely to support two projects within the same organisation. 6.2 Organisations that can apply as partner organisations In addition to the organisations listed in the lead organisation section, partner organisations may also include the following: Other non NHS provider organisations, such as charities, patient led organisations, education bodies, companies and consultancies. Specialist societies. Evaluation or research organisations. Universities and academic bodies. Local authorities. Commercial companies. Where a private company or a profit making organisation is involved as a partner, we would not expect more than 15% of our funding to go to this organisation, directly or indirectly. This is not applicable to the evaluation partner (for further information please see section 5.9). Partner organisations may be involved in up to three applications, and if all shortlisted, will need to discuss with the interview panel the feasibility of being involved in multiple projects. 6.3 Skills and experience of applicants The Scaling Up Improvement programme is targeted at teams experienced in large scale complex improvement / change projects. We expect that in order for the project team to have the necessary skills and expertise, a group of organisations will need to work together to form a project team. Due to the timescale and complexity of the work required it is likely that at least some of the organisations will have worked together previously or will have existing relationships. The Health Foundation is unable to help identify potential partners. Project teams will be required to demonstrate that individuals within the team have a high level of expertise in designing and implementing improvement projects, and in particular implementing change at scale. They should involve an organisation/s that represents the interests of the patient, service user or carer. Scaling Up Improvement Call for Applications round three 15

The specific expertise that applicants will need to address: Knowledge Clinical/ service area expertise. Technical knowledge of the relevant aspects of the proposed improvement. Change management including understanding of human factors. Evaluation and other methods of learning capture. Skills Measuring and data collection and analysis. Strong engagement skills and clinical leadership of the project to bring about the desired changes in clinical practice. Patients, service users and carer engagement. Experience Project management. Budget management. Project communications. Commissioning and managing evaluations. Abilities Ability to influence wider practice and opinion (for spread). Clear project leadership and accountability for delivery of the project, including financial management. Drive and commitment to deliver the project successfully within timescale. Scaling Up Improvement Call for Applications round three 16

7. Selection criteria and process 7.1 Selection criteria The Health Foundation expects a high level of interest in this programme. Applications will have to demonstrate: an identified problem that is significant and widely relevant to UK health care a (tested and evidence based) intervention how the project will scale an intervention or an approach how the project will be implemented how the project will be evaluated the skills and experience of people and organisations involved in the project the long term potential for wider adoption across the UK health service. We will aim to shortlist a diverse portfolio of applications which fit the criteria and focus of the programme, represent a good investment and will generate knowledge to add to the evidence base. The table below gives more details of what applicants will need to demonstrate. Please note that these points will correspond to the questions in the application form. Intervention or approach A well thought through, evidenced understanding of the problem to be addressed and a clear explanation of the proposed intervention or approach including existing evidence of its effectiveness. The rationale for why the proposed innovative intervention(s) is an effective approach to addressing the problem and how it will result in improvement for the intended beneficiaries. A clear understanding of the contextual factors that could challenge the work along with credible strategies for overcoming these. A convincing analysis of the strategic and stakeholder context for the proposed project. A description of how the intervention represents good return on investment for the organisation/s, the Health Foundation and the NHS. People and organisations Evidence that the project team either contains, or will have access to, the necessary expertise and experience to undertake a project of this complexity. A description of the relationships between the organisations involved in the project team and how they intend to work together including mitigations for potential changes within organisations and key personnel over the lifetime of the project. Scaling Up Improvement Call for Applications round three 17

Evidence that service users, staff and other stakeholders have been engaged and will be involved on an ongoing basis in the planning, co-production and delivery of the project. Demonstration of commitment from senior leaders in all organisations involved as well as how the project will fit into existing organisational and governance structures. Implementation and delivery plan Clear plans to show when and how the project will be implemented. A description of the spread or scale methodology proposed including how adopter sites will be chosen and supported to implement the intervention or approach and sustain behaviour change. Evidence that potential barriers and challenges to the project have been considered along with credible strategies for overcoming these. A detailed measurement framework, including metrics and a description of existing baseline data, and an explanation of why these are appropriate. Plans for sustaining and continuing to spread the improvements at the end of the Health Foundation funding of the project. Evaluation Demonstration that the lead organisation has experience of working closely with evaluation providers and / or commissioning evaluations of improvement interventions. Demonstration that the evaluation partner has experience of evaluating improvement interventions, and an understanding of the particular challenges to evaluation design of improvement work and / or complex interventions. They should have a track record of publishing, and plans to publish, in peer review journals. An evaluation plan / design that will show the effectiveness of the project / intervention and that will generate a detailed understanding of how, and why, this was (or was not) effective. This should be in accordance with best practice guidelines, such as the MRC guidance on Developing and evaluating complex interventions. Clear identification of the methodology that will be used and the rationale for its use, and evidence that the evaluation partner is experienced in the chosen methodology. An evaluation plan / design that includes evaluability assessment, or a convincing rationale for why this is not appropriate. Scaling Up Improvement Call for Applications round three 18

7.2 How to apply Once this Call for Applications has been read in full, please use our website at www.health.org.uk/scalingup to access our online application process. You will initially be taken to the online self-assessment eligibility tool. If there are any questions that have not been addressed by this Call for Application, applicants should email the Health Foundation at: scalingup@health.org.uk in the first instance. Please ensure you have checked all information provided in all sections of the form before confirming final submission as applications cannot be retracted to add further information. You will have the opportunity to save progress as you complete. The deadline for completed applications is 12 noon on Wednesday 17 May 2017. 7.2.2 Self assessment eligibility checking Applicants who are interesting in applying for the programme should complete an online eligibility checking self-assessment form at www.health.org.uk/scalingup. These questions are designed to ensure that your application meets the programme criteria and that you are an eligible applicant for the programme. If the criteria are met, you will be directed to the online application form. The screening tool can be completed more than once. 7.2.3 Information call We will hold an information call on Tuesday 18 April 2017. The call will last an hour and you are able to submit questions in advance. If you would like to join the call, please register your interest at www.health.org.uk/scalingup and you will receive joining instructions. Information calls offer applicants the opportunity to hear more about the programme and ask questions to clarify understanding. Please note that we will not be able to answer specific technical questions about individual applications. You are strongly encouraged to participate in the information call. If you are not able to participate, you are advised to read the FAQs document shortly afterwards as it will be updated with questions raised at the Information call. 7.2.4 Application assessment The application process is likely to be highly competitive. Applications will first be assessed by staff at the Health Foundation. Those applications that do not fit the key criteria of the programme will be rejected at this stage with others progressing to external review. Due to the volume of applications expected, we will not be able to provide detailed individual feedback. We will aim to shortlist a diverse portfolio of applications which fit the criteria of the programme, represent a good investment, will generate knowledge and add to the evidence base. 7.2.5 Interviews Scaling Up Improvement Call for Applications round three 19

Shortlisted applicants will be asked to attend a selection interview in London (travel costs including accommodation and expenses to attend the interview will be reimbursed by the Health Foundation). A maximum of five members from each project team will be asked to attend. We expect representation from individuals from the core team across the partnering organisations who will be involved in the implementation of the project. Feedback will be provided to those teams that are selected for interview but are unsuccessful at this stage. 7.2.6 Site visits Following the interviews, the Health Foundation may choose to conduct a due diligence process with the preferred applicants through a paper exercise and in person site-visit. The applicants will be expected to arrange an agenda for a 2-3 hour site visit for a small number of the Health Foundation staff. The site visit should take place at a lead / partner organisation and/or adopter sites location. Preferred applicants are expected to ensure participation of key stakeholders, from the lead and partner organisations. This may include senior sponsors who have provided statements of support for the project. Applicants will have an opportunity to indicate preferred timing for this visit on the application form and we will make every effort to take this into account when scheduling visits. Following a satisfactory site visit report an offer of an award will be sent to the lead organisation which will initiate the contracting process. 7.2.7 Key dates Activity Date Open for applications 3 April 2017 Information call 18 April 2017 Application deadline 17 May 2017 Invitation to interview 18 August 2017 Interview shortlisted applicants 18 20 September 2017 Site visits to preferred applicants 9 20 October 2017 Interviewed applicants advised of outcome 30 October 2017 Contracting and start of set-up period 1 November 2017 Start of the implementation period 1 May 2018 Scaling Up Improvement Call for Applications round three 20

8. Working with successful projects 8.1 Support from the Health Foundation In addition to financial support, the Health Foundation will provide successful project teams with the following: tailored coaching support to help teams unblock challenges they encounter expert input on a range of relevant issues and topics which could include health economics, measurement and evaluation, sustainability and spread for example regular contact with the Health Foundation s Improvement team to review progress and offer support where possible access to a wide range of the Health Foundation tools, guidance and research support to showcase and present the outcomes, impact and learning of projects to other projects, the Health Foundation and key stakeholders at a regional and national level. opportunities to connect with other project teams and to strengthen existing networks or develop new networks. The Health Foundation will work in a partnership with other organisations to provide this support programme. 8.2 Programme events Throughout the course of the programme, the Health Foundation will arrange up to five learning events. The funding provided should be used to pay for travel (and associated expenses) for up to six project team members at any event. These events will either take place in central London or be hosted by some of the project teams (quite likely on a regional basis). The Health Foundation will consider covering any accommodation expenses (where necessary). 8.3 Project management and reporting In addition to clinical leadership, projects should have a dedicated full-time project manager who has experience of managing complex multi organisation projects. Together they will be the Health Foundation s first point of contact and will have responsibility for delivery of the project including financial management. Reporting requirements will include: End of the set-up phase review to discuss progress and issues. Regular six-monthly project progress reporting including financial statements showing spend against the agreed budget. An interim evaluation report. Scaling Up Improvement Call for Applications round three 21

A final report, which should provide a route map to help other organisations understand how to deliver the changes implemented by the project; which may be published on the Health Foundation website. 4 A separate final evaluation report intended for publication on the Health Foundation website. Project teams may also be asked to host site visits for Health Foundation staff and key stakeholders for learning purposes. As will be detailed in the award agreement, funding will be made available through phased payments to the lead organisation throughout the project, subject to satisfactory progress of the work. The lead organisation will be responsible for administering the financial aspects of the award to the partner organisations. We advise partnership applications to agree internal payment processes and mechanisms at the point of application. We will expect budget reconciliation at the end of the project, signed off by the authorised finance officer in your organisation. Any unspent funds must be returned to the Health Foundation. If costs change over the funding period or if unanticipated costs arise this can be discussed with the Health Foundation. We are unlikely to approve any additional funds. 8.4 Communications Applicants will need to clearly demonstrate how the learning from the project will be communicated, both internally (within the project team s organisations) and to wider (national and international) stakeholders. The Health Foundation has developed a practical guide on how to effectively communicate and spread improvement work intended for those actively engaged in health care improvement work. As part of the project s communication strategy, project teams may choose to present papers/posters at relevant conferences. These should be made available for publication on the Health Foundation s website. 8.5 Intellectual property Any intellectual property generated from the Health Foundation s funding will be owned by the organisations delivering the project but must be licensed to the Health Foundation to support its charitable objectives. A draft of the award agreement, including intellectual property clauses, will be circulated to teams invited to interview. Applicants might find it beneficial to discuss how intellectual property will be shared by the project team organisations during the application stage. Applicants invited to interview will be expected to show the arrangements the project team have jointly agreed for dealing with intellectual property generated by the project. 4 Publication will be at the Health Foundation s discretion. Scaling Up Improvement Call for Applications round three 22