This section of the website is aimed at colleagues supporting medium and long term planning of NHS and care services at a system level. There are resources available to help start your demand and capacity journey as a system, and understand fundamental principles and modelling approaches to enable healthcare system transformation.

What’s your role and what are you looking for?

We know that many colleagues will be looking for an introduction to system level demand and capacity and how to get started with it. You may want to understand what are the suitable analytical approaches for system modelling that integrate population health management and the delivery of NHS and care services across a pathway or locality. You may be working directly at the system or for a particular provider, however, engage in system level projects, which spans across a number of providers and sectors.

Within this section of the website our resources are designed for colleagues taking part in system level demand and capacity planning from a diverse range of backgrounds, clinical, operations, analytics, transformation, etc.  The resources here are designed to support you on your journey.

About system level demand and capacity planning

System modelling is a way of analysing and modelling complex interactions between organisations and processes at a strategic level, such as an integrated care system (ICS) view.

This kind of approach incorporates population health management to underpin medium and long-term planning for workforce and other such resource. System modelling also supports evidence-based decision making for healthcare system transformation.

Modelling demand and capacity at provider organisation or service level uses a different approach. If you are looking to model at a provider organisation or service level, have a look at our service level models here.

How can system level modelling help with delivering better healthcare?

In order to identify which modelling or simulation approach is appropriate for a project at system level (e.g. ICS, locality or region), it is key to first understand what sort of question is trying to be answered through analytics.

The role of a system leader is to coordinate services and organisations in a way that improves population health and reduce inequalities between different groups. They will often work on questions such as ‘how can we make this happen?’ and ‘what actions should we take to make this better?’

What appear to be simple questions become highly complex when applied to systems that interact with each other, and outcomes will not always be intuitive or obvious. Techniques such as System Dynamics, Discrete Event Simulation and Agent Based Modelling are typically used for modelling systems at the level of complexity seen at regional or system level.

Using these methods, we can get different organisations across a system to naturally work closer together and take a more patient centred approach to meet short and long-term challenges. Also as a result of using system level modelling approaches, we can create a model that spans primary care, acute, community, mental health, and social care. The model can be used to test interventions before committing valuable resources and time to them.

System dynamics

System dynamics is one of several system modelling approaches that can be used to understand the behaviour of complex systems over time.

System dynamics can be used to test policy interventions for strategic issues, while accounting for the complexities and interdependencies in health and social care systems.

System dynamics enables systems to look at patient’s pathways on one screen and be able to virtually make changes and see the impact on the whole system before committing valuable resources and time to them.

System dynamics uses stocks and flows to capture the structure of the system. A simple example of a single process in a System Dynamics model can be seen here:

Here we can see flows (referrals and discharges) of patients coming in and out of a stock (waiting list). Depending on the rate of incoming and outgoing flows, the stock will rise or fall. In simple terms, if you have more referrals than discharges, then you will have more patients waiting over time. Can you think of the population in your locality using stocks and flows too?

The pattern of flows can be affected by any number of variables – e.g. seasonal patterns for referrals. If these factors relate to another part of the system, then this may be a feedback loop.

For example, increasing inpatient discharges to community settings may result in decreased waits in an acute setting, but may increase demand for community services.

A typical system level model will include many such feedback loops, which is where the value of using this method becomes clear.

Getting started with modelling

To use system modelling effectively, it is key to have the following things in place before you begin:

Having the right team:

• Clinical, operational, and business intelligence/analytics representation from a range of organisations and sectors across the system are essential to producing a useful and insightful model.

Having the right support with your system leaders:

• A clear commitment to support the work, including developing skills where necessary, and with buy-in across the system.

Having the right sponsorship:

• Influence or authority to act on insights developed from the modelling will be needed to make meaningful change.

The modelling process is an iterative cycle of model development, refinement, and testing. This process of learning is what generates deep insights into how systems may respond to different policy interventions, so it is worth viewing as an ongoing process rather than a one-off exercise.

Further resources

There are further resources available to support with demand and capacity modelling at system level.

FutureNHS workspace

The FutureNHS demand and capacity workspace is a legacy online collaboration platform for NHS colleagues. The workspace is a repository of additional resources that is available to support with different aspects of your demand and capacity journey.

There is a system modelling resources including some of the following:

• Case studies
• Webinar recordings
• Learning and development opportunities
• External resources