Research Question: What are the impacts on health, health inequalities and related outcomes of implementing or changing contractual levers in services commissioned by local government? https://www.nihr.ac.uk/documents/18149-contractual-levers-in-local-government/21597
Contractual Levers in Local Government
Local government has the potential to improve health and health inequalities by supporting behaviours that can help populations maintain a healthy life. Local authorities hold many types of contracts with a range of providers. Changing these contracts could offer levers to shape local conditions and environments.
While interested in contractual levers available to local government, the programme would consider applications looking at the use of contractual levers by other large local employers or organisations, including the NHS’s non-patient care contracts.
A range of study designs and outcome measures could be used for different issues/contract changes examined. The structures, processes of development and outcomes of these contracts are of interest, as is their use in a Health in All Policies approach. The nature of the impacts of such policy changes may make such interventions particularly suitable for evaluation as events within complex adaptive systems. Researchers will need to identify and justify the most suitable methodological approach.
Commissioning brief: Studies should generate evidence to inform the implementation of single or multi-component interventions. Studies may include evidence syntheses, studies evaluating interventions, including trials, quasi- and natural experimental evaluations, and feasibility and pilot studies for these. We welcome applications for linked studies (e.g. pilot + main evaluation). Secondary analyses of existing epidemiological data and/or impact modelling studies may also be funded. We encourage the adoption of a systems perspective where appropriate to the study context. In all cases a strong justification for the chosen design and methods must be made.
The primary outcome measure of the research, if not necessarily the intervention itself, must be health-related. The positive or negative impacts of the intervention, including inequitable outcomes should be considered. Researchers are asked to indicate how long-term impacts will be assessed. All applications should identify underlying theory and include a logic model (or equivalent) to help explain underlying context, theory and mechanisms. Proposals should ensure adequate public involvement in the research.
For all proposals, applicants should clearly state the public health utility of the outcomes and the mechanisms by which they will inform future public health policy and practice. Details about the potential pathway to impact and scalability of interventions, if shown to have an effect, should be provided, including an indication of which organisation(s) might fund the relevant intervention(s) if widely implemented.