Bradford District Care NHS Foundation Trust, a simulation modelling project
The Trust had developed a proposed trajectory of change for its acute mental health care pathway. There were, however, some concerns about the feasibility of aspects of that plan, and we were asked to provide an independent assessment of the changes. Following a first stage report focussing more narrowly on the acute care pathway, we were asked to expand the work to take in the full range of community mental health services for adults of working age.
We designed a discrete event simulation model and populated it with local activity data. Over an iterative series of, in total, five multidisciplinary workshops, we explored a range of scenarios for service change, and identified both pressures and opportunities to develop services to relieve those pressures. The workshops were supported by a series of 40 individual interviews with members of Trust staff, enabling us also to build up a detailed qualitative understanding of the functioning of local services.
Our work identified the following as key action areas:
•Development of an enhanced crisis assessment service to reduce demand for admission.
•Retention of more beds within the local health economy than was previously planned.
•The need for additional supported accommodation places within the local economy.
•Introduction of a complex care service.
•A change in the balance of work undertaken in primary and secondary care.
In each case, our recommendations included exactly quantified projections as to the capacity and demand assumptions on which the Trust can base their planning. These recommendations have formed the basis of subsequent Trust action; this has in due course led to the creation of a First Response service, providing a coherent response to urgent mental health referrals of all types.
Following implementation of the work arising from this project, the Trust saw a very sharp reduction in the number of overspill acute placements. They have recently marked over a year with no acute overspill at all.
The outcome of the project will enable us to further develop our longer term vision with local CCGS and the Local Authority, as well as other external partners. It has already helped us to consider the internal changes we might wish to implement in the future, as it has provided us with the necessary qualitative and quantitative data to be able to build a model which reflects our desire to progress swiftly yet safely in order to improve the quality of our services. All of the recommendations are being taken forward through our steering group and executive processes.” Nicola Lees, Director of Nursing