Influencing NHS decision making: modelling for urgent and emergency care

I’m on a journey to influence NHS decision making using mathematical modelling at a strategic level. My aim is to support local policymakers on what services to provide, where and with what capacity, particularly regarding the provision of urgent and emergency care.

The obstacles I’ve encountered on this journey have been numerous but overcoming them has led to new relationships, a better understanding of the structures within the NHS (see the diagram below). It has also reinforced my confidence that my work can help deliver more efficient care.

In search of data…

Based on my previous work in mapping healthcare networks [1] and modelling capacity in the South African context of HIV/AIDS test laboratories [2] I wanted to look at how Urgent and Emergency Care (UEC) provision in the NHS could be better arranged to meet local demand in the Hampshire region.

I set out making and building relationships with people in several different, distinct parts of the NHS and attempting to discover how modelling can support their decision making. With relationships developing and my understanding of the NHS growing, I found that I was still missing one key component: the data to feed my mathematical modelling and demonstrate its general usefulness. The process of securing that data has led to an organic and exciting change in direction of my work.

 

Relationship building: contacts via contacts

During my sabbatical of February to May 2015, and now in my secondment to the NHS since December 2015, I’ve been building relationships with people in different parts of the NHS – and contacts have led to more contacts! Thanks to those identified through University of Southampton colleagues, I’ve been talking with people in NHS England and Southampton City Clinical Commissioning Group (CCG). This has led to further contacts with South Central Ambulance Service (SCAS), with whom I currently have an honorary contract, and also with SW Hants System Resilience Group (SRG). NHS England oversee the English UEC Networks or Sustainability and Transformation Plans (STPs). They are responsible for the commissioning and monitoring of UEC Vanguards to provide integrated UEC services according to the Five Year Forward View. SCAS provide emergency services over two wide areas: firstly, the Thames Valley and, secondly, Hampshire. As such, SCAS has a wider strategic remit than the numerous NHS commissioning bodies and provider trusts within their boundaries. Finally, contacts within SCAS have led to contacts in Primary Health Care Sciences Team / Oxford University.

Snakes and ladders!

The modelling of an entire UEC network that I was originally planning has had to be revised for two reasons. Firstly, on the ground, I’ve come to the understanding that such networks exist to-date in the NHS as committees that meet perhaps monthly, and not as integrated services sharing capacity. Secondly, the data needed for such modelling in is kept by many separate CCGs and trusts, as well as ambulance services, and is difficult to access. By implementing my new found knowledge of the direction of travel for reforms of UEC within the NHS (see graphic) I have revised my modelling plans to focus at the level of an SRG.

During my research, I’ve found out that NHS England have asked consultants to do modelling of UEC access using some of the simulation techniques I’ve considered – disappointing but at least it proves I’m on the right lines! However, I hope and believe that the geographical choice modelling that I’m planning will add an extra dimension to planning future services [3].

Moreover, a new research direction has emerged in the journey. My previous research has looked at patients’ choices in accessing health care [3] but I’d not thought about the choices that NHS clinicians make in referring patients onwards, e.g. to Accident and Emergency departments (A&Es). With my newly-found colleagues at the University of Oxford, we have permission to analyse data on the referrals made by Out of Hours (OOH) general practitioners, and I’ve been given ethical approval for the University of Southampton to host this research.

So my initial learning has delivered the right unit of the NHS to be working with, uncovered a modelling need I was unaware of and delivered some new relationships inside the NHS and in academia. I’m looking forward to receiving data regarding SW Hants SRG and SCAS operations in this area. When the data become available, I will be seeing how OOH referrals combined with SCAS transferrals affect arrivals at A&Es.

At a time of increased strain on the Urgent and Emergency Care within the NHS in England I hope that my modelling will provide valuable insights to policymakers on how best to allocate resources in both regional and national contexts.

Dr Honora Smith – Honora is a lecturer in Operational Research (OR), within Mathematical Sciences at the University of Southampton. Her main research interest is in OR for health care applications.