Balance of Care: the Biography of a Model

Paul Fortewww.balanceofcare.com

CRESS Policy Modelling in Practice Workshop London 8 December 2014

The biography of a model

• First developed in early 1970s– Complex mathematical optimisation:

‘black-box’– Data hungry, requiring large-scale surveys

• Redevelopment from mid 1980s– Simplified mathematics: ‘glass-box’– Data peckish: existing survey data reused plus

local data sources and assumptions

• But… fundamental consistency of model throughout its development

The Balance of Care model

Highdependency

Lowdependency

Independent sector

Local authorities

Care home

Extra care housing

OlderPeople

Care assistantoption 3

Mediumdependency

option 2

Hospital bed

Option 1Community nurse

Physiotherapist

NHS

Occupational therapist

Tensions in the system

Care Professionals Non-Clinical Managers

Health Services Social Services

High Dependency Low Dependency

Applications

• Policy formulation– HIV/ AIDS– Intermediate care– Telecare

• Policy implementation– Older people’s services– End-stage renal dialysis– Paediatric gastroenterology– Oncology

Dealing with data

• NHS data and information: ‘wood for the trees’

• Early version required special, large-scale surveys to provide data

• Redeveloped to overcome data problems: a ‘data-less’ model concept

• Not all data required from the outset; ‘good enough’ is sufficient to engage and begin to explore strategic perspectives

• Makes best use of what’s available locally

Dealing with expectations

• Managing the ever-present desire for instant gratification and the ‘right answer’

• ‘Something which is free can’t be any good’• ‘Something which is simple can’t be any good’• Client competence – not everyone can grasp the

local ‘big picture’• Who pays for the work – and its consequences?

Identifying the audience

• Value of model in helping to identify and include relevant stakeholders – tricky when there’s potentially a large number of them…

• … and they don’t always get on• Those with the purse strings are usually those

who call the tune• Language and ‘translation’ between different

groups

Accessing Policy Makers• In Department of Health

– BoC seen as ‘mostly harmless’– little dissemination support

• In NHS– individuals with local leverage– academic dissemination through teaching and

conferences– ‘workshop’ concept– problem of ‘whole system’ model where its

constituency exists more in theory than practice

• A continuing problem…– larger number of organisations– more competition and jostling for - and protecting -

positions

The Policy Modelling Challenge

• Inertia and ‘reorganisation mentality’– difference between recognising and complying with local

agendas - but still important to challenge the status quo– be ambitious, but don’t have unrealistic expectations – if you’re really ‘implementing’, people often become

defensive. You’re not often thanked for identifying where gains and losses might accrue

– can be an emotionally difficult situation, but you have to get used to it. It’s only human nature after all…

Success factors

• Adaptability/ durability of the model– across location, domain and time

• Simplicity vs complexity– conceptually as well as technically

• Process/ outcomes– recognise that the modelling journey often proves

as or more valuable than any results

• Pitch– ‘decision support’ system– look and feel is issue-focused– not intimidating to people who may be experts but

not in modelling