NHS Operating Framework

The NHS Operating Framework has set out the timetable for reform and whilst the detail for some areas still needs clarification, there are some policy initiatives that would benefit from the use of simulation. We set out below our take on where to use simulation to help.

• The QIPP challenge continues to be a priority – saving £20bn by 2014/15. Both SIMUL8 and Scenario Generator are being used to model the impact of QIPP initiatives and test whether they will deliver expectations. Including new tariffs in simulations helps to model the impact of the new financial arrangements.



• The new PCT clusters will support emerging consortia, the development of commissioning support providers and the emergence of the new system. The NHS Institute purchased Scenario Generator licenses for all PCTs in England. PCTs should make sure that these licenses are up to date and located with the commissioning support units so that they can be used to support GP consortia. Contact admin@scenario-generator.com for information.


• Local Councils will be developing new Health and Wellbeing Boards to integrate local commissioning across the NHS. Social Care and Public Health, the new Public Health Service, will be developing at national and local level shadow arrangements by end 2011/12 in full by 2012/13. The new release of Scenario Generator contains social care pathways and prevalence and will be a very relevant tool for supporting the work of the new Boards.


• A "revolution in patient information, empowerment and choice" is intended – this is still under consultation, but tools and techniques that help patients to visualise and understand impacts and outcomes will be key. Using simulation to demonstrate change is powerful and compelling.


• The first NHS Outcomes Framework will set out the key measures to be tracking over the next few years and will form part of the first mandate for the NHS Commissioning Board from April 2012. Model and simulate pathways and expected outcomes. At SIMUL8 we will be creating demonstration models of some of these outcome measures as they are published.


• The National Quality Board will advise on what changes are needed in order to ensure the NHS has the optimal ability to prevent, detect and respond to quality failings. There will be two phases to the review: Phase 1 will consider how best to maintain quality and safety during the transition, with a view to providing guidance early in 2011. Phase 2 will consider how the early warning system might work once the new architecture for the NHS is in place, and will provide ongoing policy advice. Assessments of the quality impact of planned changes to workforce or services should take place. Simulation can help to model the impact of any change in a risk-free environment, and can identify triggers as part of an early warning system.


• New measures of quality for ambulance and Accident and Emergency services will concentrate on measures that link to outcomes. SIMUL8 was originally used by the DH to model the 4 hour waiting target. We will be producing a new model that includes the new measures.


• This NHS Operating Framework will also create clearer incentives to drive integration between health and social care by giving PCTs responsibility for securing post-discharge support, with hospitals responsible for any readmissions within 30 days of discharge. PCT allocations also include funding of £150 million for reablement and PCTs will receive separate allocations totalling £648 million in 2011/12 to support social care. The new Scenario Generator release which includes social care will be able to help to model how best to deliver this objective. At a more operational level, SIMUL8 is being used to model patient discharge.


• The NHS will be expected to implement the forthcoming Improving Outcomes Strategy for Cancer. Patients should have timely access to diagnosis and treatment and be seen by the right person with the appropriate expertise. In particular commissioners and local providers will need to ensure services are being planned, commissioned and delivered based on the current suite of cancer waiting time standards. Simulation is the only technique which can effectively model and simulate waiting times. Our breast cancer simulation model demonstrates how this works. Contact us for a demonstration healthcare@simul8.com


• Screening improves clinical outcomes. Commissioners need to work with their cancer networks to ensure that all screening services are able to continue to take part in the breast screening age extension randomisation project, either screening women aged 47-49 or 71-73, depending on the randomisation protocol; ensure that all local centres maintain the two-year screening round for bowel cancer; ensure that cervical screening results continue to be received within 14 days. Commissioners should work with their local services and NHS Cancer Screening Programmes to implement HPV testing as triage for women with mild or borderline results, leading to a more patient centred service and major cost savings. SIMUL8 has been used to model the 14 day turnaround for cervical screening, bowel cancer screening, and prostate cancer screening.


• There remains scope for improving stroke outcomes. See our case study on simulating stroke outcomes including specialist rehabilitation in the community.


• The Mental Health Strategy, due to be published in early 2011, will make clear the interdependence of physical and mental health and the need for a balanced approach to investment to achieve improved health outcomes for all age groups. The strategy will encompass the twin objectives of improvement of public mental health and wellbeing, and delivery of high quality patient centred outcomes by health services. Early intervention and prevention should be used further to reduce the likelihood of mental illness developing, including within groups at high risk such as offenders. Scenario Generator already includes mental health pathways which have been used to model commissioning changes by a number of PCTs


• Emergency preparedness and resilience across the NHS continues to be a high priority. It is essential that all NHS organisations have well developed plans in place to manage exceptional surges in activity. SIMUL8 was used by the DH to model the potential impact of swine flu and NHS Worcestershire is currently running a winter pressures simulation using SIMUL8


• The introduction of the best practice tariff for hip fracture in 2010 has proved successful in transforming the care on admission of those who suffer fragility fractures each year. PCTs are also asked to take steps to reduce incidence. The best way to prevent this transformative injury is to recognise precursor or “herald” fractures and give patients a bone health assessment and treatment when they first show clear signs of being at risk. See East Riding’s example of a falls pathway for an example of simulation in this field, using Scenario Generator.