STP Modelling
Urgent Care & Social Care Integration

System Rebalancing


The whole of the NHS is looking at new models of care. How to re-balance Acute and Intermediary care while integrating with Social services. How to look after elderly populations: keeping them well and out of hospitals.  


The big questions are:

  • What choices do we have in order to ensure we meet our objectives.

  • How can new technologies and approaches best be deployed

  • What would be the impact of these  technologies and choices on the current system?

  • Can we describe these in sufficient detail so we can:

    • build and adapt the business case? 

    • convince ourselves, the greater team and the public that we can deliver better health at a more affordable price.

Making and sustaining this change requires hard numbers to back up the vision. To do so you must be able to rigorously 'Model your future change'.



That's where we help.

Modelling is essential to engagement and buy-in

Engagement through analytics and modelling are essential components of any change programme.   A good model, that creates a tangible and believable set of figures will focus, drive and motivate your whole team.


Rigor helps to persuade

Modelling based on evidence is central to the development of the whole change rationale.  It should fundamentally support the vision and create the framework from which the business case is constructed. To do this the model must represent the key aspects of the change. It must be rigorously constructed, and equally importantly, it must be seen to have rigor. That is, not only must you develop the right figures; those engaged must also be confident they're right. Without this you will not achieve buy-in, nor will you be able to drive your project.


Reduce anxiety and overcome barriers

Change will always cause anxiety.  Our experience is that it is much better to be able to see (through a believable model) what change looks like, and discuss the reasons, rationale and impact of change, rather than arguing over speculation, or worst fears. Imagined or unsubstantiated differences cannot be resolved.


Design in adaption (and adoption)

Good modelling allows managers and clinicians to interact with the model.  This means creating user friendly models where managers and clinicians can  alter key inputs in order to see what the consequences are.  This ability is the counterpart to transparency.  Allowing those engaged to alter some of the inputs to the model to adapt to local conditions and preferences can dramatically influence those engaged to buy into the whole process. It also will usually allow you to use the modelling on an ongoing basis as the change embeds.

Bedfordshire CCG: Strategic Modelling 

Clinical Utilisation Reviews / Risk Stratification



This was an Integrated Care project for Bedfordshire CCG, where Healthcare Decisions were engaged by the SCW CSU to find and model for the client significant performance and quality improvement. The objectives included providing evidence and options for a new model of integrated community service that combined health and social care.  The work had to fit into a regional strategic Outline Case, that had just been undertaken by McKinsey.

Using what data was available, as well as our own existing models for population based preventative care, and avoidance modelling based on Clinical Utilisation Review data, we were able to create credible/robust models for the client. This described for them not only the changes to existing acute and intermediate heath care services (and consequential GROSS savings) but also the re-investments required.

Thus, we were able to explore the NET financial impact of this fundamental change and the sensitivities of the new system to key options in relation to existing local service resourcing.


Our findings were that significant savings could be found in acute services, however the investments required in the community where also significant. We determined that the NET savings would became very dependent on the implementation’s ability to re-allocate local resource and control some key parameters.

Approach & Objectives


The work was undertaken in the context of the CCG’s existing strategic vision and national policy.  It was evidence-based, using the best data available to the CCG, and made use of existing and bespoke models which could be revisited as new data became available and objectives changed.

The principal objectives of this work were:

  • identify target area(s) to match Bedfordshire CCG’s ambitions;

  • verify the ‘real’ savings potential (Net savings not Gross);

  • to set out what significant change would look like in terms of beds to the acute services (whilst ensuring sustainability);

  • identify choices to be made before embarking on detailed service re-design (develop the detailed business cases based on local data – risk and utilisation reviews)

  • to identify the workforce required across health and social care to deliver the new models of care in the community – to manage people at home and within step up and step down beds;

  • to develop the detailed business cases based on local data and based on custom built models that incorporate the underlying assumptions of predictive risk and utilisation reviews;

  • start the engagement with managers, clinicians, local authorities and providers – to ensure this strategy works for the local health economy, is embedded early, and builds credibility through its robust methodology.

“Having figures we could all look at.....”

Director Strategy & Redesign ,

Bedfordshire CCG

“Having figures we could all look at.....”

Programme Director,

Bedfordshire CCG


Community Nurse,

Bedfordshire CCG