Basic paper structure

Nosokinetics

Opportunities and challenges for modellers in NHS reforms

Peter Millard (Editor)

Nigel Edwards, Policy Director, The NHS Confederation, 29, Bressenden Place, London, SW1E 5DD, kindly enabled us to use his IMA conference slides to craft his opening talk at the IMA Conference.

Government is changing the NHS from a professionally led system, with top down planning, to a more flexible management system where the patient is in control. The move towards a Primary Care Trust system involving health and social care increases the need for the development of appropriate modelling tools.

Targets, though achieving their purpose are now recognised to have distorted the system. The reform agenda, seeks to increase patient choice and quality of care through payment by results, new contracts, plurality of provision, autonomous providers, new providers and practice based commissioning choice.

Box 1 (above) shows the changes being made and the Box 2 figure (below) shows the theory that underpins the change. Up and coming issues concern safety and quality outcomes and experience, and efficiency and cost reduction.

Frontline systems will increase the use of guidelines, systematic approaches and the need to understand variation and the implications of how systems work. Anticipatory care will increase, as will interest in risk protection and issues concerning safety and reliability. Also interest in statistical process techniques and special and common cause variation will increase.

A characteristic of clinical processes is that they are often complex, non-standard and dynamic. Thus the nature of illness and the consequent use of shared resources raises issues of concern. For many of those running the systems have faulty conceptual models and limited access to tools.

Nigel listed many problems that need to be overcome. Seems that health and social care modellers will be in business for many years to come.

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