Using Simulation Modelling to Test the Impact of Service Change – lunch and learn – 17 December 2015

www.england.nhs.uk
Using Simulation
Modelling to Test the
Impact of Service
Change
Claire Cordeaux, Executive Director,
Health and Social Care, SIMUL8
Corporation
Julie Renfrew, LTC year of care
commissioning programme, NHS England
Beverley Matthews, LTC Programme
Lead, NHS England
Thursday 17 December 2015
Long Term Conditions
Improvement Programme

www.england.nhs.uk
LTC Framework
Commitment
to Carers
Frailty
Health Ageing
Guide
Fire Service as
an asset
Care Homes
Quick Guides
Care & Support
Planning
Navigating Health
& Social Care
Self Care
Ambitions for
End of Life Care
Our Declaration
Delivery Models
Planning for Change:
• Capitated Budget
• Contracting
• Simulation Modelling
Patient and
Service Selection
Planning for Change:
Workforce
Whole Population
Analysis;
Understanding your
population
LTC Dashboard LTC Toolkit

www.england.nhs.uk
Date Topic Led by and details of session Venue
15 January
2016
12pm – 1pm
How a telephone based coaching
model at large scale can help with
admission avoidance and enhance
quality of life for people with LTC
Magnus Liungman & Chris Bound
Health Navigator Limited
Via Webex
TBC Implementing the six Quick Guides to
bring clarity on how best to work with
the care sector.
www.nhs.uk/quickguides
Via Webex
TBC Self-management in the community
and on the Internet
Peter Moore, The Pain Toolkit Via Webex
TBC The success and impact of lay health
coaches
Anya De Longh & Jim Phillips Via Webex
LTC Virtual Learning Community Lunch & Learn webinars:
Sharing and Learning …

www.england.nhs.uk
Long term conditions resources
Simulation model
Unbundling recovery simulation model

www.england.nhs.uk
7
Using behavioural
change to open minds
#A4PCC – Action for Person-Centred Care
Person with
long term
condition
o Make a declaration at
www.engage.england.nhs.uk/survey/ltc
-declaration
o Tell your teams about our work
o Encourage them to make a declaration
o Ask them to feed back thoughts and
ideas
o Use our hashtag – #A4PCC – when
you see work that is relevant to
person-centred care for people with
LTCs
o Let us know of any events, activities or
social media opportunities that we can
join forces with you

www.england.nhs.uk
Using Simulation
Modelling to Test the
Impact of Service
Change
Claire Cordeaux, Executive Director,
Health and Social Care, Simul8 Corporation
Julie Renfrew, LTC year of care
commissioning programme, NHS England
Beverley Matthews, LTC Programme
Lead, NHS England
Thursday 17 December 2015
Long Term Conditions
Improvement Programme

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
How might the
tool help you?
LTC YoC Simulation
tool
Testing your integrated care service models
for patients with complex care needs

 Theoretical test before implementation
 Test before you commit resources
 Evidence to support a business case
Why use the simulation tool?
To assess variation
• Set budget
• Staffing
For scenario planning
• Will it save money?
• Will more GPs be needed?
• Will emergency admissions
be reduced?

What does the simulation do?
• The simulation models how people with multiple long
term conditions use health and social care services over
a typical year.
...segmented in up to four groups
...each group having a different likelihood of accessing various services over
a year.
• Services are associated with costs and with resource
use
• The simulation can run for up to 10 years.
• Patients may move between groups as the years pass,
join or leave the patient cohort
• Users can test the impact of changes in service models
prior to implementation.

Service managers, commissioners, finance managers from
both commissioning and provider organisations:
 Those making decisions
 Those planning change (service, workforce, budget)
Informatics and IT professionals:
 Baseline information
 Manipulation of the model
 Interpretation of scenario parameters
 Sense checking results
Who should use the simulation tool?

A bit about the
underlying data

 BHR whole population data – 10% with highest risk score
 Four resource-usage categories – very high (0%-0.5%); high (0.05%-
2.0%); medium (2.0%-5.0%); and low (5.0%-10.0%).
 Acute, community, mental health and GP practice primary care (no social
care)
Distributions of data within the
model:
 Likelihood of a patient accessing services
 Number of times a patient attends or is admitted
 Costs for each attend/admission type
 Resource use for each attend/admission type
Data underpinning the model

Changes over time:
 Likelihood of leaving cohort
 New patients entering
 Transition between resource-usage categories
Need to understand where differences might affect your
results:
 Activity types
 10% of population
 Distributions and changes over time
But most of these are likely to have a small impact. Your
planned service change is still likely to have the largest impact.
Baseline data within the model

How the tool works

A Year of Care
39%
9%
40%
22%

A Year of Care – next level
56%
13%
62%
40%

SIMUL8 Corporation | SIMUL8.com | healthcare@SIMUL8.com
• Group
patients by
level of
acuity
• Increasing
numbers of
long term
conditions
What drives the model

• Patients in each group
access services
• Often more than once
• Each service is a
associated with a range
of costs
• Each service has an
associated capacity
How it works
Patient
Services
Costs
Capacity

A Year of Care – analyst view
56%
13%
62%
40%

How should I set the
tariff for different patient types and how does
this compare against reference costs?

What does this mean for A & E
activity?

Baseline and
scenarios

Baseline versus scenario
 Differences in activity, cost and staff
 Differences in the change in activity, cost and staff
over time
Scenarios have been included to
illustrate the type of service
changes you might wish to test
using the simulation tool
Running the model

Based on evidence from the Scottish multimorbidity programme:
• Provide services in GP practice and community care to prevent
‘avoidable’ emergency admissions in acute hospitals.
• Targets current and future high consumers of health and social care
(10% of the population with highest risk scores).
What Qs might the tool help give you some direction on...
 Would the new service be cheaper? How much cost would shift from
acute services to primary and community services?
 How many new community, MH and GP practice staff would be
needed?
Scenario 1 (built into the tool)

Based on introduction of a care navigation service.
The fundamental elements of the care navigation approach are:
 Proactive case finding (2% of the population; no split to separate care usage
groups)
 Resources shift from acute services to community, mental health & GP
primary care services
 Care co-ordination by an integrated care team - based around a GP practice,
facilitated by the voluntary sector (the care navigator)
 Care navigator support on a 1:1 and group basis to: develop goal specific to
each individual; encourage physical and social activity; and to link patients
with local assets and key ‘community makers’
The major difference between Scenario 1 and Scenario 2 are:
 10% versus 2% of the population included in the patient cohort
 Patient cohort split to 4 care usage groups for Scenario 1, versus no groups
for Scenario 2
Scenario 2 (built into the tool)

Your Own Service Change Scenario
• A Wizard walks you through how to create a new
service change scenario and reduce access or
attendance at other services
• E.g. The impact of an enhanced GP service on A&E
and urgent admissions

Additional features

Results
• All results export to a formatted spreadsheet
to allow easily analysis and comparison

Cost Results
• Cost comparisons: Tariff vs Reference costs
vs Actual

Other additional functionality
1. Population
– Annual projected growth now
included
– Runs up to 10 years

2. Incidence
– Changing year on year
– Runs up to 10 years

3. Costs
– Service cost
– Reference costs
– Annual deflation/inflation#

4. Capacity
– Staff or bed requirement for each service

Accessing the
simulation tool

Over to you….
• Download the viewer and access the free
simulation tool:
www.nhsiq.nhs.uk/ltcyoc
• Use online or download to your PC
• To support you...
– Quick Start and Analyst User Guides
– Frequently asked questions document
– ‘How to use the tool’ step by step video

Upgrade option…
• Save your own simulation with local data and
share with colleagues via online portal
• Access the data template for easy upload
• Individual coaching from SIMUL8 Corporation

Contacts
SIMUL8 Corporation:
healthcare@SIMUL8.com
0141 552 6888

www.england.nhs.uk
Long Term Conditions Improvement Programme
Using simulation modelling to test the impact
of service change
Claire Cordeaux Julie Renfrew Bev Matthews
Executive Director, LTC YoC Commissioning Programme LTC Programme Lead,
Health & Social Care NHS England NHS England
Simul8 Corporation
Questions and discussion

Using Simulation Modelling to Test the Impact of Service Change – lunch and learn – 17 December 2015

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Using Simulation Modelling to Test the Impact of Service Change – lunch and learn – 17 December 2015