Acute Respiratory Infection Hubs

Background

Acute respiratory infections are one of the main reasons people seek NHS care all year round, but especially during the winter. To help manage this demand, the Acute Respiratory Infection (ARI) hub was introduced in England in 2022, and by 2023, there were more than 300 located across England. 

ARI hubs are designed to give adults and children with respiratory symptoms faster and more appropriate assessment and treatment. By doing so, they aim to reduce demand on GP surgeries and prevent unnecessary visits to emergency departments. 

The ARI hub model is based on care delivered through COVID-19 assessment hubs that operated during the pandemic. However, while the ARI hub model has the potential to ease the pressures on the NHS, we still know little about how these hubs have been set up, how they work in practice, and the impact they are having on a national scale.

We need more evidence on how ARI hubs are implemented and their impacts to inform future policy, guidelines, and practice, and to understand what works and why. These insights will underpin future outcomes and economic evaluations, forming the basis for practical recommendations. 

Approach

To understand how an intervention like ARI hubs makes a difference, you first need to know its characteristics; the resources used, the actions taken, and the results produced. Once you understand this, its impact can be measured to find out if the intervention was working.  

This 12-month process evaluation aims to build a detailed picture of how ARI hubs operate across England. The study will explore the characteristics of these hubs and inform the design and implementation of a future evaluation to understand their impacts. 

The process study will involve desk-based research, a survey of ARI hub leads to gather information on hub structures, staffing, and delivery models, and interviews or focus groups with key stakeholders.  

Stakeholders will include ARI hub leads, clinicians, representatives from Integrated Care Boards, Primary Care Networks, and NHS hospital trusts, as well as patients and carers. 

In addition, the study will develop a theory of change to explain how ARI hubs are expected to deliver their impacts. This will be co-developed through a workshop involving ARI hub representatives and national and regional NHS stakeholders. 

The study will address three main research questions: 

• How are ARI hubs arranged and delivered across England, and what operational or contextual factors influence their delivery? 
• What outcomes and impacts do stakeholders expect ARI hubs to achieve, and what data are currently collected to assess their effectiveness and costs? 
• What is the feasibility of conducting an outcomes and economic evaluation of ARI hubs, and what design would be most appropriate? 
  

Project team

Robert Romanelli

RAND Europe

Professor Graham Martin

THIS Institute

Jon Sussex

RAND Europe

CG

Callam Gunn

RAND Europe

Manon Richard-Sheridan

RAND Europe

Kiri Dargaville

THIS Institute