What is the IPACs project?
The IPACS project team have developed modelling tools to help health and social care services build capacity by managing their care and resources for people discharged from hospital needing home-based care.
What is the background?
The transfer of patients following an acute hospital admission – either to their own home or to a non-acute bed for a limited period of time – with community health and social care support is a complex process. It requires planning and management that is both efficient, from a system perspective, and effective, in terms of the impact on the health and wellbeing of patients and their families. The process is often characterised by delays and capacity issues. These are inextricably linked with the availability of suitable care capacity in appropriate locations at the right time which is a key determinant for access and, inevitably, rationing and queues.
The lack of availability of social care services is a particular contributor to these system pressures as it is often the ‘end point’ of the care chain. Across England, in 2019, around 500,000 acute bed days were lost to discharge delays which were directly attributable to non-availability of social care. However, no single organisation is accountable for managing or funding the entire process or is responsibility for the bottlenecks and gaps in the delivery of the service frequently occur as a result.
How are researchers trying to help?
There is a proven track record of modelling issues such as these in healthcare, although rarely with this particular focus. IPACS researchers have developed a computer-based decision support tool for managers and planners to gauge the likely efficiency and effectiveness of potential decisions affecting the flow of patients along the complex discharge care pathway.
Using locally available, linked data, the model enables testing of a key assumption that any additional investment in increasing social care capacity might be more than offset through reducing demand in more expensive upstream acute care settings. The premise is that improved capacity distribution throughout the whole system not only improves cost-efficiency of services but also enhances the experience and health outcomes for patients and their families.
What has happened so far?
Now into its third year, the IPACS focus has been on developing and piloting a model for different aspects of the discharge pathway. We have successfully gained support and interest of local key stakeholders across the different BNSSG health and social care organisations.
The IPACS model is now being used to explore different capacity allocation strategies both at the individual organisation level and across the system as a whole. The aim remains to provide local decision-makers with greater clarity and understanding about how the overall care system works and how best to prioritise capacity decisions across it.
What happens next?
IPACS researchers will continue to work on technical modelling developments and corresponding application work with local stakeholder organisations. They also aim to engage patients, clients and the wider public more directly, keeping them as the central focus of hospital community discharge process. Where appropriate they will aim to improve efficiency and effectiveness, creating a ‘virtuous circle’ of improvement in use of resources and quality of care, something the research team feel is important in the current service provision climate.
Improving hospital discharge flow through scalable use of discrete time simulation and scenario analysisDownload the Conference paper
- The False Economy of Seeking to Eliminate Delayed Transfers of Care: Some Lessons from Queueing Theory
- Optimising the balance of acute and intermediate care capacity for the complex discharge pathway: Computer modelling study during COVID-19 recovery in England
- A Demand and Capacity Model For Home-Based Intermediate Care: Optimizing The 'Step Down’ Pathway
- Improving hospital discharge flow through scalable use of discrete time simulation and scenario analysis
- University of Bath
- NHS Somerset Integrated Care Board
- NHS One Devon Integrated Care Board
- NHS Cheshire and Merseyside Integrated Care Board
- NHS Bristol, North Somerset and South Gloucester Integrated Care Board
- NHS Bath and North East Somerset, Swindon and Wiltshire Integrated Care Board