Helping the NHS understand what works

Tell us a bit about the IAU and why it was set up? 

The IAU was set up to provide rapid and robust evaluative feedback on some of the new models of care being introduced in the NHS. What’s different about our approach is that rather than doing simple before and after comparisons, we’re able to go deeper and ask what would have happened in the absence of the intervention. We do this by creating carefully selected control groups so that we can compare outcomes and truly understand the impact of the new service or innovation.  

Why is it so important to have this kind of analysis to guide the development of improvement initiatives on the ground? 

By providing rapid and robust feedback on new ways of delivering care in the NHS, we’re helping decision makers know what’s working and where to invest in further roll out. A notable example of this was our evaluation of various interventions introduced as part of the Enhanced Health in Care Homes programme. Our analysis showed the potential to reduce emergency admissions to hospital for care home residents using this approach. This influenced the national roll out and our work informed policy set out in the NHS Long Term Plan.  

Another area we worked on was understanding the impact of integrated care initiatives. While there was already quite a lot of evidence showing short-term results, we had a unique opportunity to look at the longer term impact. We went back to some of the early initiatives involving multidisciplinary teams, revisiting them 5 or 6 years down the line to see how they'd impacted on emergency hospital use. That work has really helped to establish an understanding that although integrated care initiatives are very beneficial to patients, it often takes much longer before these models can bring savings to the wider system. It shows that local health and care teams need to be given time and resources to develop new models of care. 

How does the work of the IAU complement the wider work of the Health Foundation? 

Just presenting a piece of quantitative analysis doesn't necessarily tell decision makers what to do next. Our work becomes much more powerful when we work in collaboration with others, combining evidence from our studies with insights that already exist from the work of other analysts and academic teams.  

In particular, we work closely with the policy and improvement teams at the Health Foundation. The IAU combines knowledge and insights with quantitative evidence to make tangible recommendations to stakeholders.  

We’re also part of the Health Foundation’s wider data analytics team, collaborating on data sets, sharing learning, and inputting on research.  

What do you think have been the IAU’s biggest successes so far? 

There are two things I’m particularly proud of. The first is around our novel use of data. As a by-product of needing to interpret data for our evaluations, we’ve created new ways of using data that are having a much wider impact.  

For example, as part of our work evaluating interventions in care homes, we ended up developing a new metric to allow us to identify care home residents from within hospital records, previously something very difficult to do. That metric is now widely used by the NHS and was particularly relevant when the pandemic hit, meaning it fed into SAGE modelling on outbreaks of COVID-19 in care homes.  

We’ve also just published a paper on what we call ‘household context factors’. Patients’ health care needs are determined by many factors, not all captured in hospital or GP records, for instance social context. We’ve devised a way of identifying people in different household settings, for example those who live alone, or people who live with one other person with a frailty condition (an indicator they may be an informal carer). That’s giving us access to new information that we couldn't previously use. And we’ve already found some very strong links. For instance, someone living alone is 9% more likely to present at A&E, and 14% more likely to have an emergency admission, even after you adjust for other known predictors of hospital use.  

The second thing I’m proud of is how well we’ve been able to work with policymakers to ensure their decision making is informed by robust data in real time. Our work on digital first primary care is a good example of that. Our team has regular catch-ups with key stakeholders and members of their teams within NHS England. That allows NHS England to stay abreast of our emerging findings and ensures our work stays relevant to the challenges they're facing.  

What's changing at the IAU and what sort of projects do you have planned in the future? 

There’s a strong commitment from NHS England to continue working in partnership with us but going forward we’re also hoping to expand the scope of our work.

We’d like to do more to encourage better use of robust evaluation in decision making in the NHS. Mostly that’s about building skills and capacity. We want to help policymakers and decision makers understand what good evaluation looks like and encourage them to ask for the sort of robust evidence they need. And we want to help analytical teams in the NHS by providing tools and guidance and sharing some of the methods we’ve developed over the last 6 years.  

We’re also keen to broaden our horizons beyond just England, for example working with the devolved nations to evaluate interventions there too. And we’re looking for new ways to collaborate with other organisations for greater impact. We’re already part of a £2.2m study (funded by the National Institute for Health and Care Research) to pilot a minimum data set around care home residents – working with 10 other organisations who all bring different knowledge and perspectives to the table. We’d love to do more of this kind of work, collaborating and sharing learning in ways that will add to the evaluation landscape.  

The thorough and timely approach to evaluation that our team has developed at the IAU is making a unique contribution to assessing improvement in the health service. By helping this approach to spread across the health and care system we’re enabling more evidence-informed decision making, which will help to improve the quality of care for all.  

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.