Title: HS&DR evidence synthesis centre
Funder: Department of Health and Social Care

Abstract: Accessible, clear and timely syntheses of research and other evidence lie at the heart of any system of evidence-based health service design, management and delivery. NHS managers, clinical leaders, and commissioners regularly face important uncertainties in their decision-making, and yet there is often research and other evidence which – if located and effectively synthesised and summarised – may better inform their decisions. This 3-year programme of work will involve conducting rapid systematic reviews, scoping reviews and other relevant research projects to directly inform NHS, health care and social care organisation and delivery. The exact topics, timings and deliverables of the component reviews will be provided by the NIHR HS&DR programme and negotiated and with the team on a regular basis. While the methods of systematic review in health care have evolved largely to compare the effectiveness of alternative treatments, it is increasingly recognised that both ‘conventional’ systematic review methods and other more innovative methods of evidence synthesis (such as realist review or meta-ethnography) can also address important questions about alternative models of care, alternative care pathways, alternative service configurations, or alternative service management and commissioning approaches. Depending on what research has been conducted in these areas of uncertainty, an evidence synthesis will sometimes be able to provide overarching conclusions about the effectiveness and cost-effectiveness of a particular form of care. However, because the same-named service model will typically comprise different components in different organisations or places, be implemented more or less well, and operate differently in different local or health system contexts, single reliable answers to the question of ‘What works?’ are rarely forthcoming. Instead, the methods we use in our systematic reviews aim to recognise this complexity and context-dependency, and acknowledge that the real questions asked by most managers and commissioners are more contingent and locally specific, for example: ‘What will be most effective, acceptable and implementable here, with my current staff-mix and organisational/commissioning arrangements, and within my budget?’ etc. This means identifying and drawing upon diverse sources of evidence, for example: published and in the grey literature, qualitative and quantitative research evidence, empirical evaluations and discussion/policy reports from the UK and abroad and evidence that covers health service goals beyond effectiveness and cost-effectiveness (e.g. acceptability, accessibility, service quality, safety, responsiveness). It also means synthesising evidence in a way which is sensitive to the varied contexts in which past research has usually been conducted, and recognising limitations in generalisability to current NHS organisational structures and practices. This requires experienced systematic reviewers with an understanding of how health systems work and key service issues, the confidence and ability to work well with NHS managers or other topic experts on new review topics, and importantly dedicated time in the review process for dialogue and ‘sense-making’ as well report-writing.

Lay abstract: The experienced academic team formed to lead this work (Rob Anderson, Jo Thompson Coon and Chris Cooper) together have over 29 person-years of leading and producing policy- and NHS-facing evidence syntheses, including: • Over 10 years of conducting systematic reviews as part of Health Technology Assessments for NICE, for the NIHR HTA Programme, Home Office and other national policy customers (RA & JTC since 2005, CC since 2009) • Over 6 years of producing evidence syntheses in response to local and regional NHS clinical and management uncertainties as part of NIHR CLAHRC South West Peninsula's research prioritisation processes (JTC, leading the PenCLAHRC Evidence Synthesis Team within ESMI since 2009) • 3 years conducting a programme of rapid reviews of the effectiveness, cost-effectiveness and ‘barriers and facilitators’ of public health programmes (from 2008-11 ESMI was a Collaborating Centre of NICE’s Centre for Public Health Excellence, led by RA). CC worked on the same work programme for NICE, but at King’s College, London). Evidence Synthesis & Modelling for Health Improvement (ESMI): Alongside these programmes of work we have also produced other methodologically innovative systematic reviews of complex health care/public health questions and diverse study types. The ESMI research group at the University of Exeter Medical School has proven systems for recruiting, training and retaining skilled research staff, managing projects, report writing to tight deadlines and negotiating review protocols to ensure that reviews are useful and deliverable within available resources. See who we are and follow what we do at: http://medicine.exeter.ac.uk/esmi/ Methods expertise: We have established excellence in conventional methods for conducting systematic reviews of the effectiveness and cost-effectiveness of health interventions and services. We have also conducted systematic reviews to answer more diverse questions, for example to: better define key concepts (intermediate care), compare international policies (road injury prevention), and assess the feasibility and implementation of programmes. Our wider methodological expertise includes skills in meta-analysis, qualitative thematic analysis, theory-driven review, meta-ethnography, realist review, and linked syntheses which combine quantitative and qualitative evidence. We also have one of the strongest teams of research-active information specialists in the country (led by CC). Links to subject experts: We have excellent connections and pre-existing collaborations with health care management researchers including: • in the Business School (Prof Andi Smart, Director of the Organisations in Transition (OiT) Research Cluster) • Plymouth University (Prof Rod Sheaff, School of Government). • Close connections with PenCLAHRC, the local NHS, and the AHSN (Academic Health Science Network); User-friendly reports: ESMI has an excellent reputation for producing reports that are tailored to the needs of particular audiences, and use plain and compelling English. As much as feasible, we engage with subject experts or other relevant stakeholders to ensure our reports are as credible and useful as possible.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE