Innovating for ImprovementOutline application form

Deadline for submission of the outline application:

12 noon, Tuesday 4 August 2015

Important information: The Health Foundation reserves the right to close ahead of the outline application deadline date if this programme is oversubscribed. We anticipate a high volume of applications and therefore encourage applicants to submit outline applications early, ahead of the deadline to avoid disappointment.

Project title (as per answer 1.1 below)Lead organisation (as per answer 1.2 below)Type of organisation(as per answer 1.2 below)Primary contact(as per answer 1.3 below)Partner organisation(s) (as per answer 1.4 below)Proposed budget (£) (as per answer 1.7 below)Please fill in this table before submitting your application. You should repeat the answers that appear in the application questions below.

The Health FoundationTel: 020 7257 8000www.health.org.uk

Guidance on the outline application form

Please ensure that you have read the Call for applications before completing the outline application form. The outline application requires information related to the selection criteria as described in section 3 of the Call for applications.

Outline applications are accepted on the basis that the Health Foundation can share the content with external colleagues who will assist us with assessments.

When completing your application form, you should use lay language and answer each question in a concise manner. Please use Arial font size 11 and keep to any word limits given. Please specify the actual word count within each question. Any information that exceeds the word limit will not be read. Your budget must be submitted as an appendix using the supplied template. Do not attach any other appendices or additional information, as they will not be considered. PDF documents will not be accepted apart from the signature page. References and diagrams or charts can be included within the text boxes and are excluded from word limits.

Guidance on completing the outline application form is incorporated into the form and greyed out. This guidance page and all the grey boxes should be deleted before submitting your application.

Make sure you have saved the application form to a Word document to your own computer before you start to fill it in. The outline application should be saved as a Word document using the following format: ‘Innovating for Improvement - Lead organisation name - Lead contact name - Application form.doc’ and should be submitted via email using this title.

Please email your completed outline application to innovating.applications@health.org.uk by 12 noon on Tuesday 4 August 2015.1 We are unable to consider late applications. Please note that we will not accept duplicate/revised application forms so please make sure that you have the final, correct version before sending. Hard copies will not be accepted. If any sections are removed, omitted or incomplete we will not accept the application.

If you need to supply your signatures securely using pdf format, please make sure that you submit this page at the same time as your main application using the same naming protocol. If you do not submit signatures within the main application or separately as a pdf within the same email as the main application, your application will be rejected.

We will only select the strongest applications that fully meet the eligibility and selection criteria for the programme to proceed to the full application stage. Full application forms will be emailed to successful applicants by Monday 12 October 2015.

Due to the volume of applications expected, we will not be able to provide feedback to unsuccessful applicants at the outline application stage.

If you have any questions, please contact us at innovating.enquiries@health.org.uk.

1 The Health Foundation reserves the right to close ahead of the outline application deadline date if this programme is oversubscribed.

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1 About the application

1.1 Project title

The title should be short and descriptive; and should not exceed 20 words.

1.2 Lead organisation

Organisation name

Type of organisation

Registered address

Statement (if applicable, please use this space to address any of the bulleted points below)

You should tell us what type of organisation is leading the project. The organisation named here should be the organisation within which the innovation is being tested and must provide or deliver health services free at the point of care in primary, secondary or tertiary care, or across boundaries such as health and social care.

The organisation named here will be responsible for planning and delivering the project. It will be accountable to the Health Foundation for reporting on project progress including project spend. This organisation will receive the funding from the Health Foundation and should be able to manage the budget and distribute it among any partner organisations through local agreements as required.

A lead organisation must be legally constituted. It may be constituted as an NHS body, a ‘not for profit’ organisation (eg a charity or a company limited by guarantee), a social enterprise, a company limited by shares, or a community interest organisation.

The following must be addressed in your statement above, if applicable: If you are a non-NHS provider of health services, the organisation must be

commissioned or in an authorised position to provide services (eg registered with Care Quality Commission in England). You should provide a statement that more than 50% of your work is with NHS funded patients (we will require evidence to this effect, if you progress to the full application stage).

If the intervention/s is being delivered to a new group of patients or staff, where a service does not currently exist, eg virtual care or community based person centred initiatives, the application should be from a lead organisation responsible for establishing and sustaining the new initiative.

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 Foundation would need to be convinced that our funding is going to the

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non profit making arm. We strongly recommend that NHS service provider organisations (lead organisations) are only involved in a small number of applications from different divisions of the same organisation. We will only accept one application per project lead.

Please refer to sections 3.5 and 4.1 of the Call for applications.

1.3 Primary contact

Full name (and title)Job title

Role on this projectOffice/contact addressEmail

Telephone

Length of contract

You should name a person from the lead organisation (as named in 1.2) who will be the project’s primary contact. This should be the person who the Health Foundation can contact if we require further information or clarification throughout the assessment period and preferably the duration of the project. This is the person with whom we will make contact about the progress of the application. S/he should have an in-depth knowledge of the project proposal and we need to know what their role is within this particular project.

It is essential that the primary contact is able to champion the project and have influence within your organisation. Therefore we require the primary contract to be on a contract that is due to last until at least the end of the funding period in August 2018. Those on secondment or a fixed-term post that is due to last beyond August 2018 are welcome to apply.

1.4 Partner organisations

Name of partner organisation Organisation type Role within the project

Add more rows as necessaryApplicants will need to show that they have the skills and understand the processes required for successful innovation. Where an applicant organisation does not possess the range of experiences and skills needed, it is expected to link up with other organisations such as universities, consultancies and innovation intermediaries in order to secure the right skill mix within the team. Ideally they should involve an organisation(s) that

Innovating for Improvement – Outline application form 4

represents the interests of the patient, service user or carer. The size of the project team may vary depending on the expertise of the individuals involved.

Please refer to sections 4.2 of the Call for applications.1.5 Have you or your organisation applied to the Health Foundation before?

Yes / No

1.6 If yes, please tell us the name of the lead organisation, the name of the primary contact, the name of the award scheme, the year the application was made, the reference number (where known) and the outcome of your submission and application.

Application 1

Org name Primary contact

Programme / scheme

Year Reference no.

Outcome

Add more rows as necessaryThe Health Foundation welcomes applications from previous applicants. This question is for information only and will not affect your application to this round of Innovating for Improvement.

1.7 Total amount of funding requested

£

1.8 Length of project in months

2 About your proposed project

2.1 Please provide an overview of your proposed project. (400 words)

Actual word count:Please provide a summary of your project in lay language clearly explaining the aims, objectives (outputs and outcomes) and innovative approach/intervention. You should include a brief summary of the problem, explain how your project is innovative, describe the setting(s) in which the intervention will take place (eg organisations, wards, departments, etc) and in what locality/localities. You should also describe the specific and tangible improvements in quality that you seek to achieve and the key measures you will use to evidence your improvements. This is only a summary: you will be asked to provide more detail on key aspects of your project in subsequent sections.

Please refer to sections 3.2 and 3.5 of the Call for applications.

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2.2 Please describe the nature and severity of the problem your project seeks to address. (300 words)

Actual word count:Please give a clear description of the nature of your problem, clearly explaining the problem, the cause, nature and severity, as well as its impact on patients.

We are looking for applications that provide evidence of a clearly identified problem or potential problem that you want to address, which is a significant quality issue, widely relevant to UK health care and for which potential improvements should be practical and generalisable.

Please 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. You 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.

Please give an overview of what the current service/service provision is for patients, and how this relates to the problem, so that the improvements you propose are clear.

Please refer to sections 3.2 and 3.5 of the Call for applications.

2.3 What is the intervention/solution you are proposing and how will it address the identified problem? (300 words)

Actual word count:Please describe what the intervention is. This answer should include:

where it will take place (eg patient services, departments, wards) and in what locality/localities

which clinicians, service users, patients, carers in the project will be involved in testing and carrying out the intervention

the number of service users and patients that will be involved in your intervention and how they will be recruited

an explanation of the rationale and how the proposed innovative intervention(s) will address the problem and thus result in improvements

an explanation of how your intervention will improve care, either directly or indirectly, within the life of the award, including your key outcome measures.

You should tell us why this intervention will work in your setting and how it will work in the context of your project (ie how it aligns with your organisational approach). You

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should also explain how your proposed intervention differs from the current provision/service if it already exists.

You should demonstrate that the intervention is well designed, with detail about the resources that will be used. Please refer to sections 3.2 and 3.5 of the Call for applications.

2.4 Please choose the descriptor of innovation that your project corresponds with (highlight one box only). Please be realistic about the descriptor you believe your project corresponds with.

Descriptor 1: Innovations with no previous history in any context – they are

genuinely new or novel

Descriptor 2: Innovations transferred into health care from another sector such as

another public service body, another industry or non-health related field.

Descriptor 3: Innovations transferred into the UK health care sector from overseas

health care systems.

Descriptor 4: Innovations transferred or adapted from one health care setting to

another: for example, adult care to paediatrics, social care to health care.

2.5 Why have you chosen the above descriptor of innovation? (200 words)

Actual word count:You should explain what your decision process was in choosing the stated innovation level.

If you have chosen two, three or four please tell us about the setting where it has been used or tested, including the organisation, the scope of the work and any key people who are leading the work.

In our review of Round 1 and 2 applications, we found that a number of applicants selected descriptor one or two and did not back this up with very strong evidence. It is important that your selection is realistic and that you can demonstrate the justification for your chosen innovation through evidence. For example if your innovation is a collection of methods that have all been tried and tested in other health care settings then we would not consider this to meet the level one descriptor.

2.6 What is innovative about your intervention/approach and what evidence do you have to support this? (300 words)

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Actual word count:You should explain what is innovative about your intervention/your particular approach and how it is innovative. You must be able to demonstrate that your intervention is innovative and explain what sets it apart from other approaches.

We need to be convinced that your approach is genuinely innovative. We will not support any potential solutions to problems in health care delivery or quality that have already been tested in the same health care setting. We will give preference to the most innovative proposals during the selection process.

It is critical that you provide robust evidence to support your proposal. Tell us about the evidence you are drawing on to demonstrate that your approach/intervention is genuinely innovative. You should explain clearly the link between existing evidence and your intervention.

You should be fully aware of innovations that have already taken place in your area of interest, have an understanding of the theoretical background to the intervention, and provide evidence of implementation in other settings, sectors or industries as appropriate.

You should demonstrate knowledge of the field, current practice and relevant national and international published and grey literature. You are expected to have consulted with key experts and appropriate clinical or other networks in the UK and internationally. You are expected to detail their search strategy – for example, the terms used for the literature review – and discussions with named stakeholders and experts.

Please refer to sections 3.1 and 3.5 of the Call for applications.

2.7 Please describe your change methodology – what are you going to do (deliverables), when (milestones) and how will you set about doing it (method)? (300 words)

Actual word count:Please explain what improvement approaches you will be using for your intervention. Tell us what you will be testing, what you will be implementing and how you will manage the implementation.

Please clearly detail the key timelines for all deliverables and high level milestones of your intervention, to show what you are going to do when. This should include the set-up phase (recommended) followed by implementation and including measurement.

If your project is likely to need ethical/R&D approval you should include this as one of your milestones, ensuring you have enough time to make the necessary enquiries that will enable you to have final approval and be ready to start your work by August 2016.

Please refer to sections 3.2 and 3.5 of the Call for applications.

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2.8 Please describe your measurement plan: what are you going to measure, how and when? (400 words)

Actual word count:You should set out your measurement plan – to include details of:

what you are going to measure which measures and indicators you will use how the data will be collected and presented when the data will be collected and presented who within the project team will be responsible for this.

The expected benefits should be clearly stated and their measurement clearly explained.

This programme is specifically targeted at projects that will equip people to manage their own conditions and health care more effectively, or equip health care providers to improve the quality of care provided to their patients on a daily basis. It is important that your measurement plan clearly demonstrates the anticipated benefits of your project in these areas and how this will be measured.

We want to see a breakdown of your outcome measures (how the changes impact on patients and other stakeholders), process measures (whether the changes in the system are performing as planned and if you are on track in efforts to improve the system) and balancing measures (whether changes designed to improve one part of the system are causing new problems in other parts of the system).

Please refer to section 3.4 and 3.5 of the Call for applications.

2.9 Tell us about the experience, expertise and responsibilities of the core project team, ie those who will be closely involved in the project on a day-to-day basis.

Name Current role

Role in project

Relevant expertise and connections to relevant expert/specialist networks or community of practice

Time allocated to the project (FTE)

Example please delete:Dr Joe Smith

Example please delete:Consultant Psychiatrist and Medical Director

Example please delete:Project Clinical Lead

Example please delete:Clinical skills, Leading academic in mental health, Leading academic in improvement science

Example please delete: 1.0

Add more rows as

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necessaryApplicants will need to show that they have strong clinical leadership (this includes doctors, nurses, allied health professionals, etc) and should also involve people who work in the operational environment(s) where the innovation will be tested. The latter may be clinical or non-clinical, depending on the nature of the innovation. Project teams should have experience in change and project management, measurement and evaluation.

Please refer to 3.5 and 4.3 of the Call for applications.

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3 Funding

3.1 How much funding are you requesting from the Health Foundation?

Total cost of project: £

Total amount requested from the Health Foundation: £

3.2 Is there any funding from other sources (include in-kind and/or cash)?

Source Amount In-kind/cash

Add more rows as necessaryEach project will receive up to £75,000 of funding to support the implementation of the work. This funding can be supplemented by applicant organisations if appropriate. While co-funding is not a requirement, we do need to know if there are any other confirmed funding sources.

3.3 Please provide a breakdown of your proposed budget on the separate Excel spreadsheet, to demonstrate how you will use the funding.

You do not need to write anything here, it is a reminder for you to complete and submit the budget template. Please submit your budget template in the same email as the application.

Please use the template to provide an overview of the budget. Your budget should contain detailed costs that are your best estimate and, where appropriate, based on written quotations. Please round the total to the nearest whole £.

Our award must only be used to cover costs that are directly attributable to carrying out the project. The Health Foundation will not fund capital expenditure such as:

vehicles or buildings large items of equipment (over £2,000) including scanners, printers, 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 additional clinical posts linked to the specific intervention, unless there is a very

convincing case for how these posts will be sustained beyond the funding period.

Please add more rows and headings as and where necessary giving as much detail as possible. Include subheadings in your breakdown and ensure that totals are correct.

Please refer to section 3.3 of the Call for applications.

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4 Declarations

To comply with the Data Protection Act, we require your consent for the Health Foundation using personal data supplied by you in the processing and review of this application and in any other legitimate activity of the Foundation; this includes transfer to and use by such individuals and organisations as the Foundation deems appropriate. The Health Foundation requires your further assurance that personal data about any other individual is supplied to the Foundation with their consent.

The applicant also accepts the Health Foundation’s requirements relating to the Data Protection Act (see above). The signatory below will provide this consent and assurance. The signatory below also confirms that the information provided in the application form is accurate.

Electronic signatures are required as the application form is to be returned by email. This means that signatures either need to be scanned and inserted into the Word document or the following pages should be submitted as a separate pdf at exactly the same time as the main application. We cannot accept application forms that do not include electronic signatures. We will not accept pdf/scanned copies of the main application form: this must be submitted as a Word document.

3.4 Primary contact from lead organisation (named in section 1.3)Name

Job title

Organisation

Signature

Date

3.5 A senior representative (for example the chief executive, chair or equivalent role) from the lead organisation (named in 1.2) must fully support this application by signing the declaration below:

‘I confirm that I have read and fully support this application. The organisation accepts the Health Foundation’s requirements relating to the Data Protection Act (see above). The signature below provides this consent and assurance.’

Name

Job title

Organisation

Signature

Date

3.6 A senior member of the finance team (eg Director of Finance or equivalent) from the lead organisation (named in 1.2) must fully support this application by signing the declaration below:

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‘I confirm that I have read and fully support this application. The organisation is prepared to implement this work should the application be successful and will administer the funds awarded. The signature below provides this consent and assurance.’

Name

Job title

Organisation

Signature

Date

3.7 A senior representative (for example the chief executive, chair or equivalent role) from all partner organisations (named in 1.4) must fully support this application by signing the declaration below:

‘I confirm that I have read and fully support this application. Our organisation is prepared to support this work should the application be successful. The signature below provides this consent and assurance.’

Name

Job title

Organisation

Signature

Date

Please note that we will expect a full statement of support and CEO level sign off from the key partners at the full application stage.

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For each section below please indicate which category your intervention relates to. If it relates to more than one category, please mark up to two categories for each section. Please highlight the primary category as ‘1’ and the secondary category as ‘2’. If you have anything additional to add regarding the categorisation of your intervention please add to the notes field below.

Section 1: Specialism/focus Section 2: Topic Section 4: ChallengeAnaesthesia Clinical effectiveness Clinical outcomesBlood sciences Commissioning Clinical safetyBuildings and facilities Efficiency of care Effective networksCancer Equity of care FacilitiesCardiac Healthcare policy FlowChildren and adolescents Healthcare reform Hospital readmissionsChronic disease/long-term conditions Improvement science Improving reliability

Dementia Innovation Information managementDiabetes Integration Length of stayEmergency medicine Leadership MDT workingEnd of life Measuring quality Medicine optimisationEar, Nose and Throat Organisational development Medicine safetyFamilies and carers Person-centred care Pain managementFrail elderly Quality improvement PathwaysGastrointestinal Regulation Patient experienceGeneral practice Safety Patient informationHome-based care Timeliness of care Patient reporting processImaging Workforce development Patients in the homeInpatients Reducing variationIntensive care Safe care environmentsMaternity and neonatal Section 3: Innovative solutions Self-management

Mental health - Adult Adopting methods from other industries Shared decision making

Mental health - CAMHS App development Surgical outcomesNeurology Bundles Technology to improve careNeurosurgery Clinical audit Transfer of care processNHS staff Crowdsourcing Value for moneyObstetrics and gynaecology Design of space Workforce skills and capacityOrthopaedics and musculoskeletal E-learning development

Outpatients Games developmentPharmacy Mobile/remote working models Section 5: SectorPublic health Online portals and forums Ambulance serviceRehabilitation Pathway redesign Community careRenal Reminder services Community pharmacyRespiratory Telehealth/telemonitoring GP practiceRheumatology Training guides development Hospice care

Stroke Transferring services to another setting Local authority

Substance abuse Value scorecards Mental health organisationSurgery Value stream mapping Secondary careUrgent and emergency care Web tools development Social care organisationUrology Web development University

Notes (if required)

Marketing feedback form

We request this information to help us monitor the effectiveness of our marketing activities. This information is not used in the application review process. Please tell us how you first heard about the Innovating for Improvement programme.

I received an email about the programme:From the Health Foundation From another source (please specify): ________________________________

I received the flyer about the programme:Directly from the Health FoundationPassed on by someone else (please specify): ___________________________

I picked up a flyer at an event:Clinical Human Factors Group event (December) Compassion, dignity and respect event (December) Another event (please specify): ______________________________________

I saw an advertisement or information on a website:BMJ HSJNursing StandardNursing TimesPharmaceutical Journal/Pharmaceutical MagazineCommunity CareGP onlinePulse The Health FoundationOther (please specify): _____________________________________________

I saw an advertisement in a publication:BMJ HSJNursing StandardNursing TimesPharmaceutical Journal/Pharmaceutical MagazineCommunity CareGP onlinePulse The Health FoundationOther (please specify): _____________________________________________

I saw an article in a publication: Please specify publication: __________________________________________

I saw an article in a newsletter: Please specify newsletter: __________________________________________

I found out about the programme in another way: Please specify: _____________________________________________________

Did you take part in/ listen to the information call that took place on 15 July 2015?

Yes No

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