Simulating health and social care delivery: Can the tension between individual patient path ways and strategic planning be addressed?

In this presentation we discuss the use of system dynamics to understand the delivery of health and social care. We report on the development of a simulation model to address the issues of elderly care in a local health care system in the South East of England. We explore the appropriate level of aggregation for a model to address the policy challenges faced by local care organisations. While we recognise the value of a highly aggregated systems dynamics approach and the danger of inappropriate disaggregation, we argue in the presentation that features of the care system (such as the recurrence of admissions to the hospital) make it desirable to include some aspects of patient history in a flow model of patient path ways. We examine the feasibility of a more disaggregated approach and the influence of this choice for the understanding of the system and the development of beneficial policy options. As Western societies age and the cost of providing health and social care rises, innovative approaches to the delivery of services are becoming increasingly important. Such new approaches include an increased emphasis on rehabilitatio n, the delivery of care in new settings (such as in intermediate care facilities and the client/patients' own home) and the support of care delivery by technical means (e.g. tele care systems). Health and social care delivery is a complex system whose development is strongly influenced by the actions of different actors such as h ealth and social care providers, funders, as well as vulnerable individuals and their families. Actions in one part of the care system often have unexpected and unwanted consequences elsewhere. Costs and benefits of any change are unevenly distributed across the system. Systemic thinking is therefore required to plan and implement changes effectively and successfully. In the UK, the government has recognised this, at least in principle, and promoted a "whole system approach" in health and social care planning. The System Dynamics approach is well suited for the study of policy issues in the provision of health and social care for the elderly. The published work in the area generally derives major insights from the analysis of the system structure on a relatively aggregated level. Wolstenholme (1993 and 1999), Linard (1996) and Walker and Haslett (1999) are some examples of past work in this area. Clearly, this analysis on a