Influencing and Interpreting Health and Social Care Policy in the UK

Health system modelling for policy development and evaluation: Using qualitative methods to capture the whole-system perspective

“…Another multi-sector model centred on emergency services was developed by Brailsford et al [9] used multiple qualitative models to map the relationships around emergency and on-demand care services, which then used as the basis of a quantitative model to investigate patient flow bottlenecks. Wolstenholme [10] developed both national level and regional quantitative system dynamics simulations to assess the drivers of discharge delays in acute hospitals in the UK. The models were parameterized with the available health system data to estimate the effects of various policies such as implementing intermediate care on flow bottlenecks.…”

Coping but not coping in health and social care: masking the reality of running organisations beyond safe design capacity

“…When demonstrated at a national level and at political conferences, this result was a major contributory factor in persuading the government to temporarily place on hold the idea of fining social services. A new plan emerged to allow social services to divert £100 million of investment to increasing care package capacity over a 6-month period to reduce delayed discharges prior to fines being imposed (Wolstenholme et al, 2004a). This investment took place between October 2003 and February 2004, with the dramatic effects shown in Figure 1.…”

“…Initially, this was carried out at a national level to assist the Local Government Association to influence government policy on delayed hospital discharges (Wolstenholme et al, 2004a(Wolstenholme et al, , 2007. More recently the patient flow work has been extended to assist local heath and social care communities in assessing the national results on delayed hospital discharges using their own data and to broaden the range of issues addressed (Wolstenholme et al, 2004b(Wolstenholme et al, , 2004c.…”

An evaluation of the applicability of system dynamics to patient flow modelling

“…SD is a more common approach for developing models of complex systems, focusing on typical delays at a population cohort level rather than the granular variation within these cohorts, which is more useful for strategic planning. However, while SD has previously been used to develop broad health care system models (Royston et al, 1999;Brailsford et al, 2004;Wolstenholme et al, 2008), these models typically aim to extend beyond the hospital and encompass the broader health care system at a very aggregate level. With an internal hospital focus, a less aggregate model than those mentioned above was needed, as the scope extends beyond merely accepting that variability exists and seeks to understand and reveal some of the causes of variability.…”