Experts urge NHS to use modelling approach to resolve winter A&E crisis


Key figures call for increased use of computer modelling to deal with influx of patients

Computer modelling and simulation of solutions to the NHS winter A&E crisis, currently being pioneered in a number of NHS trusts, should be adopted across the health service, senior figures have recommended.

Mike Farrar, former chief executive of the NHS Confederation; and Lord Norman Warner, former Health Minister for NHS reform, were speaking at the launch in Westminster of a new report detailing how NHS pioneers are using modelling to test-drive innovative approaches.

Test-driving change like this helps everyone to work the problem together and avoid unexpected pitfalls safely for patients and inexpensively for the NHS

Computer modelling provides a safe, inexpensive way to try new methods and avoid the unintended consequences of bed closures and changes in primary and social care that can lead to A&E crises, according to the report, entitled Emergency Simulation – How modelling is resuscitating NHS Urgent & Unscheduled Care , published today by the Cumberland Initiative.

Professor Terry Young, co-founder of the Cumberland Initiative, a network of leading clinicians, managers, modellers, academics and industry specialists who are pioneering the approach in the NHS, said: “The benefits of modelling are being felt on the ground and making a difference in the current A&E crisis. We need to ensure that policy and practice are making the most of this approach particularly during this difficult winter for the NHS.”

Lord Norman Warner, former Health Minister, added: “Trusts in London, Cardiff, Devon, Lincolnshire and Nottingham, have, as this report shows, used modelling to get the right mix of bed capacity, ambulance availability, consultant cover, ward organisation and GP support to tackle the problems many hospitals experience in their A&E departments. Other trusts should emulate them in using technology to give both patients and clinicians a better service.”

And Farrar said: “Test-driving change like this helps everyone to work the problem together and avoid unexpected pitfalls safely for patients and inexpensively for the NHS. We want NHS England to encourage greater operational use of modelling and simulation across trusts and commissioning bodies, whenever significant service or infrastructural change is being considered.”

Among the trusts detailing their experience of modelling at the Westminster launch of the report is the Royal Free Hampstead NHS Trust, which has been planning a new emergency department.

Kate Slemeck, executive director of operations at the Royal Free Hospital, said: “Simulation allows us to understand how patients flow through the hospital and test our improvement ideas before implementation. As a result, we have greater manager and clinician engagement and more confidence in our decisions.”

Other examples of using computer modelling of changes highlighted in the report are:

  • Cardiff: Modelling has shown that A&E demand is actually generally stable and crises are largely due to increases in attendance by people aged over 75
  • South Wales: Mathematical modelling convinced managers that some of the UK’s poorest ambulance response times could be tackled effectively by speeding up hospital turnaround rather than increasing numbers of ambulances
  • Torbay Hospital, Devon: Modelling has convinced managers and clinicians to rethink a bed closure plan
  • Nottingham: Modelling has shown that the best way to reduce bed occupancy and improve emergency and unscheduled care was neither early discharge nor separating majors from minors in the emergency department, but via measures to keep elderly patients out of hospital
  • Lincolnshire: Modelling has recently given managers in Lincolnshire the confidence to invest in a GP presence in A&E, to create intermediate care and to close acute beds, and simulation is being used to develop innovative funding mechanisms supporting integrated health and social care for people with long-term conditions
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Click here for more details on the report.