This document discusses using simulation modeling to test the impact of service changes for patients with long-term conditions. It describes a simulation tool that models how patients use health and social care services over time and allows testing different service scenarios. The tool segments patients into groups based on resource usage and models costs and resource use. It can test scenarios like implementing integrated community services or care navigation to reduce hospital admissions. The tool is available online and allows exporting results to compare scenarios and inform planning changes.
NHS England and partners have published six Quick Guides to bring clarity on how best to work with the care sector. They can be accessed at www.nhs.uk/quickguides
Want to find out how the care sector can support local systems in the run up to winter? Want to break down barriers between health and care organisations? Want to find out how Leicester has achieved a 60% reduction in care home admission costs? Want to finally break down the myths around sharing patient information and assessments? Want to use other people's ideas and resources?
Webinar outcomes:
Introduction to the care homes quick guides
Two examples of models referenced in the guides:
- Angela Dempsey, Baker Tilly on the Quest4care tool
- Dawn Moody on MDT working and a model implemented in a CCG
Guest Speakers: Nicola Spencer and Emily Carter - NHS England
NHS England and partners have published six Quick Guides to bring clarity on how best to work with the care sector. They can be accessed at www.nhs.uk/quickguides
Want to find out how the care sector can support local systems in the run up to winter? Want to break down barriers between health and care organisations? Want to find out how Leicester has achieved a 60% reduction in care home admission costs? Want to finally break down the myths around sharing patient information and assessments? Want to use other people's ideas and resources?
Webinar outcomes:
Introduction to the care homes quick guides
Two examples of models referenced in the guides:
- Angela Dempsey, Baker Tilly on the Quest4care tool
- Dawn Moody on MDT working and a model implemented in a CCG
Guest Speakers: Nicola Spencer and Emily Carter - NHS England
Has clinical commissioning found its voice? GP perspectives on their CCGsNuffield Trust
This slide deck presents the fourth and final year of results from an annual survey of GPs and practice managers in six CCGs across the country. The survey – conducted as part a joint project with The King’s Fund – explores how GP attitudes towards clinical commissioning have evolved since their launch in 2013.
3.4 Measuring access - Mitchell Briggs, Louise Harvey, Brian NivenNHS England
Measuring access. Measuring access in general practice. Focusing on the GP Access Fund national evaluation, the bi-annual data collection and the general practice workload tool. Mitchell Briggs, Programme Lead, Improving Access to General Practice, NHS England; Louise Harvey, Stakeholder Engagement Lead, Improving Access to General Practice, NHS England, Brian Niven, Technical Director, Mott Macdonald.
1.3 Develop the team - pharmacists - Ravi SharmaNHS England
Develop the team - pharmacists. Using clinical pharmacists as part of the practice team. Featuring experience from the national clinical pharmacists programme. Ravi Sharma, clinical lead for NHS England's clinical pharmacy programme.
Professor Liam Smeeth: Big Data, 30 June 2014Nuffield Trust
In this slideshow, Liam Smeeth, Deputy Director and Head of Department of Non-Communicable Disease Epidemiology of the London School of Hygiene and Tropical Medicine discusses big data, e-health and the Farr Institute.
Liam Smeeth spoke at the Nuffield Trust event: The future of the hospital, in June 2014.
Professor Sue Hill OBE, Chief Scientific Officer for Englandrightcare
We are excited to introduce the NHS Atlas of Variation in Diagnostic Services, the latest publication in the series of impressive NHS Atlases, which have highlighted variation in the provision of healthcare services.
Diagnostic services are of great importance in the NHS because, when used correctly, they support or rule out potential diagnoses, and underpin the effective and efficient management of patient pathways.
Unwarranted variation in the rates of diagnostic testing is of the utmost relevance to individual patients with the over-use, as well as under-use, of diagnostic tests being potentially serious issues. For example, effective capacity planning in imaging services should enable improved patient access balanced against the need to avoid over-use of interventions that have the potential to cause harm, such as ionising radiation.
Ramani Moonesinghe, Associate National Clinical Director for Elective Care at NHS England, discusses the use of data for monitoring care quality at various levels within the system.
A national learning event took place in June 2014, to explore how best to present data from the Cancer Patient Experience Survey (CPES) in order to drive improvement.
Outcomes from the event will help to shape the future presentation of CPES data, so that it is more accessible and easier for professionals and the public to use and interpret.
The event was held by NHS Improving Quality's Experience of Care team, in partnership with Macmillan Cancer Support, and NHS England's Insight team, to bring together cancer managers, lead nurses and lead clinicians. They heard from speakers including patient Bonnie Green, Ben Page, chief executive of Ipsos Mori, and Sean Duffy, National Clinical Director for cancer. Delegates also undertook group activity looking at the barriers that exist in translating data into improvement, and tailoring data for the right audiences.
The event forms part of NHS Improving Quality's wider work with NHS England looking at how the NHS is using the CPES data to reduce variation in the cancer patient experience. CPES, part of the national survey programme commissioned by NHS England, generates data and insight into the experiences of cancer patients.
- See more at: http://www.nhsiq.nhs.uk/news-events/news/using-insight-data-to-improve-patient-experience.aspx#sthash.Yh1yiQ6y.dpuf
SIMUL8 Healthcare: Cross-boundary, Cross-sector – using simulationSIMUL8 Corporation
From a recent presentation to the Cumberland Initiative. SIMUL8 Healthcare's Executive Director of Health and Social Care Claire Cordeaux discusses how simulation can be used to model integrated care to support people outside hospital. Simulation allows us to understand the impact of changing service utilization on; flow, cost and capacity / resource.
Claire also presents case studies on how simulation was used in Hepatitis C screening to prevent liver disease, and to identify and manage patients with multiple conditions as part of the Year of Long Term Conditions Year of Care.
Has clinical commissioning found its voice? GP perspectives on their CCGsNuffield Trust
This slide deck presents the fourth and final year of results from an annual survey of GPs and practice managers in six CCGs across the country. The survey – conducted as part a joint project with The King’s Fund – explores how GP attitudes towards clinical commissioning have evolved since their launch in 2013.
3.4 Measuring access - Mitchell Briggs, Louise Harvey, Brian NivenNHS England
Measuring access. Measuring access in general practice. Focusing on the GP Access Fund national evaluation, the bi-annual data collection and the general practice workload tool. Mitchell Briggs, Programme Lead, Improving Access to General Practice, NHS England; Louise Harvey, Stakeholder Engagement Lead, Improving Access to General Practice, NHS England, Brian Niven, Technical Director, Mott Macdonald.
1.3 Develop the team - pharmacists - Ravi SharmaNHS England
Develop the team - pharmacists. Using clinical pharmacists as part of the practice team. Featuring experience from the national clinical pharmacists programme. Ravi Sharma, clinical lead for NHS England's clinical pharmacy programme.
Professor Liam Smeeth: Big Data, 30 June 2014Nuffield Trust
In this slideshow, Liam Smeeth, Deputy Director and Head of Department of Non-Communicable Disease Epidemiology of the London School of Hygiene and Tropical Medicine discusses big data, e-health and the Farr Institute.
Liam Smeeth spoke at the Nuffield Trust event: The future of the hospital, in June 2014.
Professor Sue Hill OBE, Chief Scientific Officer for Englandrightcare
We are excited to introduce the NHS Atlas of Variation in Diagnostic Services, the latest publication in the series of impressive NHS Atlases, which have highlighted variation in the provision of healthcare services.
Diagnostic services are of great importance in the NHS because, when used correctly, they support or rule out potential diagnoses, and underpin the effective and efficient management of patient pathways.
Unwarranted variation in the rates of diagnostic testing is of the utmost relevance to individual patients with the over-use, as well as under-use, of diagnostic tests being potentially serious issues. For example, effective capacity planning in imaging services should enable improved patient access balanced against the need to avoid over-use of interventions that have the potential to cause harm, such as ionising radiation.
Ramani Moonesinghe, Associate National Clinical Director for Elective Care at NHS England, discusses the use of data for monitoring care quality at various levels within the system.
A national learning event took place in June 2014, to explore how best to present data from the Cancer Patient Experience Survey (CPES) in order to drive improvement.
Outcomes from the event will help to shape the future presentation of CPES data, so that it is more accessible and easier for professionals and the public to use and interpret.
The event was held by NHS Improving Quality's Experience of Care team, in partnership with Macmillan Cancer Support, and NHS England's Insight team, to bring together cancer managers, lead nurses and lead clinicians. They heard from speakers including patient Bonnie Green, Ben Page, chief executive of Ipsos Mori, and Sean Duffy, National Clinical Director for cancer. Delegates also undertook group activity looking at the barriers that exist in translating data into improvement, and tailoring data for the right audiences.
The event forms part of NHS Improving Quality's wider work with NHS England looking at how the NHS is using the CPES data to reduce variation in the cancer patient experience. CPES, part of the national survey programme commissioned by NHS England, generates data and insight into the experiences of cancer patients.
- See more at: http://www.nhsiq.nhs.uk/news-events/news/using-insight-data-to-improve-patient-experience.aspx#sthash.Yh1yiQ6y.dpuf
SIMUL8 Healthcare: Cross-boundary, Cross-sector – using simulationSIMUL8 Corporation
From a recent presentation to the Cumberland Initiative. SIMUL8 Healthcare's Executive Director of Health and Social Care Claire Cordeaux discusses how simulation can be used to model integrated care to support people outside hospital. Simulation allows us to understand the impact of changing service utilization on; flow, cost and capacity / resource.
Claire also presents case studies on how simulation was used in Hepatitis C screening to prevent liver disease, and to identify and manage patients with multiple conditions as part of the Year of Long Term Conditions Year of Care.
Delivering care outside of the hospital is seen as one of the ways of managing increasing demand for healthcare services, whilst also improving patient outcomes. Effective delivery means a huge rethink of service delivery as a system as well as by organizations, and whilst there are some blueprints for good practice, on the whole the evidence for system-wide management is sketchy.
Simulation is a really helpful technique to use when trying to predict uncertain futures. Bringing together clinical evidence for best practice with available data for current service utilization for population groups and ideas for improvement into a simulation can help drive forward decision-making for change, underpinned with the best evidence available.
This workshop will draw on a variety of projects and models to consider how simulation can help to model the impact of care outside hospital. From prevention activity (planning a new obesity and weight management service), to applying an annual capitated tariff for people with chronic disease, to managing workload in community teams, we will examine how simulation has been helping to understand the current position and to develop and negotiate a plan for change across health systems.
This workshop will look at patient care pathways and demonstrate how simulation can combine process flow across; services, clinical best practice and the progression of patients through disease states, to test the impact of improvement initiatives on patient care, outcomes, costs and resource utilization.
Using examples from recent projects on simulating care pathways within HIV services, and simulating future service needs for dementia care, we show the results of combining disease progression with service utilization.
In the workshop, we’ll consider what the ideal pathway model would look like and invite you to work with us to build a pathway using our latest technology.
The Million Hearts: Cardiovascular Disease Risk Reduction Model team hosted an open door forum on Thursday, September 3, 2015. Attendees received an overview of the application as well an opportunity for question and answers about the Model. Joining the team was Paul Meissner, Director of Research Program Development at Montefiore Medical Center, who talked about why the Model is important to his organization.
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QIPP end of life care event report - Great practice showcase – Birmingham (28 February 2012) - 05 September 2011
The Midlands and East QIPP end of life care great practice showcase event was held in February 2012. It brought together over 80 commissioners, end of life care managers and clinical staff to learn more about the tools and resources available to meet the QIPP challenge at end of life.
The event report summarises the key learning from the day, including an overview of presentations, links for further information on marketplace exhibitors and good practice case studies looking at:
Find your 1% campaign
e-Learning for care homes in the East of England
Time to Talk initiative across NHS East Midlands
The use of mobile working devices for Birmingham hospice staff.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
In 2008, SIMUL8 Corporation and the NHS Institute for Innovation and Improvement developed Scenario Generator, a strategic simulation software tool for commissioners. A free license was provided to all Primary Care Trusts and these licenses are now being made available to all CCGs and other NHS organisations at no extra cost.
Many PCT users have already taken their licenses to CCGs and into Public Health teams in local government and you can now claim your free Scenario Generator software.
The recent statement of support for using simulation in healthcare from Lord Warner and recent projects with the Year of Care Long Term Conditions and NHS IMAS teams who are using simulation to support improvement has increased NHS interest in this technology and we would be delighted to help you to benefit from using it.
The training session below will help you get started quickly with your license.
Please let me know if you would like any further support by contacting me directly on 0141 552 6888 or clairec@SIMUL8.com and I will be delighted to help.
Transforming Clinical Practice InitiativeCitiusTech
The Transforming Clinical Practice Initiative (TCPI) is designed to help small practices and clinicians achieve large-scale health transformation. The initiative is designed to support more than 140,000 clinician practices over four years duration in sharing, adapting and further developing their comprehensive quality improvement strategies. The TCPI is one part of a unique strategy advanced by the Affordable Care Act to strengthen the quality of patient care and manage health care expenditures, ultimately saving the taxpayer from substantial costs. This document describes the initiative in detail with the type of participants, eligibility and reporting requirements of the participants. Understanding the implementation of this initiative not only helps clinicians, but opens up a huge market for Healthcare IT companies offering the products and services like EHR implementation, Integration, EHR/ Data Migration, Implementation of HIE etc.
SIMUL8 Healthcare: Designing New Spaces and Processes with simulationSIMUL8 Corporation
In this workshop, Brittany discussed how simulation can be used to design new spaces and processes, not just improve the status quo.
Calling on her experience as an ASQ-certified Six Sigma Black Belt and her work on a wide variety of performance improvement projects – many of which incorporated simulation - Brittany presented a case study that demonstrates the interconnected nature of pre/post surgery operating processes and inpatient census.
We also looked at the project's unexpected findings, as well as shared insights into using simulation as a change management and leadership communication tool.
Using simulation to drive changes in health and care - long term conditions Year of Care model
Bev Matthews and Claire Cordeaux
Presentation from Day 1 of the Health and Care Innovation Expo 2014, Manchester Central
Integrated data to support service redesign decision making 19 01 2016 finalNHS Improving Quality
Integrated data to support service redesign decision making
Leeds LTC Year of Care Commissioning Early Implementer Site
Tricia Cable, Year of Care Lead
Alison Phiri, Business Intelligence Manager
Mohini Chauhan, Year of Care Commissioning Manager
Health IT Summit Houston 2014 - Case Study "EHR Optimization for Organizational Value in a Changing Healthcare Environment"
Luis Saldana, MD, MBA, FACEP
CMIO
Texas Health Resources
iHT2 case studies and presentations illustrate challenges, successes and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices. This session will be presented by a thought leader in the provider, payer or government space.
Similar to Using Simulation Modelling to Test the Impact of Service Change – lunch and learn – 17 December 2015 (20)
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Guest speaker:Dr Dawn Moody, Director - Fusion48
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Learning outcomes:
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Resources:www.fusion48.net
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Fire service as an asset: providing telecare support in the community Webinar...NHS Improving Quality
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
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3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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Using Simulation Modelling to Test the Impact of Service Change – lunch and learn – 17 December 2015
1. www.england.nhs.uk
Using Simulation
Modelling to Test the
Impact of Service
Change
Claire Cordeaux, Executive Director,
Health and Social Care, SIMUL8
Corporation
Julie Renfrew, LTC year of care
commissioning programme, NHS England
Beverley Matthews, LTC Programme
Lead, NHS England
Thursday 17 December 2015
Long Term Conditions
Improvement Programme
2. www.england.nhs.uk
LTC Framework
Commitment
to Carers
Frailty
Health Ageing
Guide
Fire Service as
an asset
Care Homes
Quick Guides
Care & Support
Planning
Navigating Health
& Social Care
Self Care
Ambitions for
End of Life Care
Our Declaration
Delivery Models
Planning for Change:
• Capitated Budget
• Contracting
• Simulation Modelling
Patient and
Service Selection
Planning for Change:
Workforce
Whole Population
Analysis;
Understanding your
population
LTC Dashboard LTC Toolkit
3. www.england.nhs.uk
Date Topic Led by and details of session Venue
15 January
2016
12pm – 1pm
How a telephone based coaching
model at large scale can help with
admission avoidance and enhance
quality of life for people with LTC
Magnus Liungman & Chris Bound
Health Navigator Limited
Via Webex
TBC Implementing the six Quick Guides to
bring clarity on how best to work with
the care sector.
www.nhs.uk/quickguides
Via Webex
TBC Self-management in the community
and on the Internet
Peter Moore, The Pain Toolkit Via Webex
TBC The success and impact of lay health
coaches
Anya De Longh & Jim Phillips Via Webex
LTC Virtual Learning Community Lunch & Learn webinars:
Sharing and Learning …
5. www.england.nhs.uk
7
Using behavioural
change to open minds
#A4PCC – Action for Person-Centred Care
Person with
long term
condition
o Make a declaration at
www.engage.england.nhs.uk/survey/ltc
-declaration
o Tell your teams about our work
o Encourage them to make a declaration
o Ask them to feed back thoughts and
ideas
o Use our hashtag – #A4PCC – when
you see work that is relevant to
person-centred care for people with
LTCs
o Let us know of any events, activities or
social media opportunities that we can
join forces with you
6. www.england.nhs.uk
Using Simulation
Modelling to Test the
Impact of Service
Change
Claire Cordeaux, Executive Director,
Health and Social Care, Simul8 Corporation
Julie Renfrew, LTC year of care
commissioning programme, NHS England
Beverley Matthews, LTC Programme
Lead, NHS England
Thursday 17 December 2015
Long Term Conditions
Improvement Programme
7. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
How might the
tool help you?
LTC YoC Simulation
tool
Testing your integrated care service models
for patients with complex care needs
8. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
Theoretical test before implementation
Test before you commit resources
Evidence to support a business case
Why use the simulation tool?
To assess variation
• Set budget
• Staffing
For scenario planning
• Will it save money?
• Will more GPs be needed?
• Will emergency admissions
be reduced?
9. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
What does the simulation do?
• The simulation models how people with multiple long
term conditions use health and social care services over
a typical year.
...segmented in up to four groups
...each group having a different likelihood of accessing various services over
a year.
• Services are associated with costs and with resource
use
• The simulation can run for up to 10 years.
• Patients may move between groups as the years pass,
join or leave the patient cohort
• Users can test the impact of changes in service models
prior to implementation.
10. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
Service managers, commissioners, finance managers from
both commissioning and provider organisations:
Those making decisions
Those planning change (service, workforce, budget)
Informatics and IT professionals:
Baseline information
Manipulation of the model
Interpretation of scenario parameters
Sense checking results
Who should use the simulation tool?
11. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
A bit about the
underlying data
12. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
BHR whole population data – 10% with highest risk score
Four resource-usage categories – very high (0%-0.5%); high (0.05%-
2.0%); medium (2.0%-5.0%); and low (5.0%-10.0%).
Acute, community, mental health and GP practice primary care (no social
care)
Distributions of data within the
model:
Likelihood of a patient accessing services
Number of times a patient attends or is admitted
Costs for each attend/admission type
Resource use for each attend/admission type
Data underpinning the model
13. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
Changes over time:
Likelihood of leaving cohort
New patients entering
Transition between resource-usage categories
Need to understand where differences might affect your
results:
Activity types
10% of population
Distributions and changes over time
But most of these are likely to have a small impact. Your
planned service change is still likely to have the largest impact.
Baseline data within the model
16. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
A Year of Care – next level
56%
13%
62%
40%
17. SIMUL8 Corporation | SIMUL8.com | healthcare@SIMUL8.com
• Group
patients by
level of
acuity
• Increasing
numbers of
long term
conditions
What drives the model
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• Patients in each group
access services
• Often more than once
• Each service is a
associated with a range
of costs
• Each service has an
associated capacity
How it works
Patient
Services
Costs
Capacity
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A Year of Care – analyst view
56%
13%
62%
40%
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How should I set the
tariff for different patient types and how does
this compare against reference costs?
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What does this mean for A & E
activity?
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Baseline versus scenario
Differences in activity, cost and staff
Differences in the change in activity, cost and staff
over time
Scenarios have been included to
illustrate the type of service
changes you might wish to test
using the simulation tool
Running the model
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Based on evidence from the Scottish multimorbidity programme:
• Provide services in GP practice and community care to prevent
‘avoidable’ emergency admissions in acute hospitals.
• Targets current and future high consumers of health and social care
(10% of the population with highest risk scores).
What Qs might the tool help give you some direction on...
Would the new service be cheaper? How much cost would shift from
acute services to primary and community services?
How many new community, MH and GP practice staff would be
needed?
Scenario 1 (built into the tool)
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Based on introduction of a care navigation service.
The fundamental elements of the care navigation approach are:
Proactive case finding (2% of the population; no split to separate care usage
groups)
Resources shift from acute services to community, mental health & GP
primary care services
Care co-ordination by an integrated care team - based around a GP practice,
facilitated by the voluntary sector (the care navigator)
Care navigator support on a 1:1 and group basis to: develop goal specific to
each individual; encourage physical and social activity; and to link patients
with local assets and key ‘community makers’
The major difference between Scenario 1 and Scenario 2 are:
10% versus 2% of the population included in the patient cohort
Patient cohort split to 4 care usage groups for Scenario 1, versus no groups
for Scenario 2
Scenario 2 (built into the tool)
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Your Own Service Change Scenario
• A Wizard walks you through how to create a new
service change scenario and reduce access or
attendance at other services
• E.g. The impact of an enhanced GP service on A&E
and urgent admissions
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Results
• All results export to a formatted spreadsheet
to allow easily analysis and comparison
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Cost Results
• Cost comparisons: Tariff vs Reference costs
vs Actual
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Other additional functionality
1. Population
– Annual projected growth now
included
– Runs up to 10 years
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Other additional functionality
2. Incidence
– Changing year on year
– Runs up to 10 years
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Over to you….
• Download the viewer and access the free
simulation tool:
www.nhsiq.nhs.uk/ltcyoc
• Use online or download to your PC
• To support you...
– Quick Start and Analyst User Guides
– Frequently asked questions document
– ‘How to use the tool’ step by step video
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Upgrade option…
• Save your own simulation with local data and
share with colleagues via online portal
• Access the data template for easy upload
• Individual coaching from SIMUL8 Corporation
38. www.england.nhs.uk
Long Term Conditions Improvement Programme
Using simulation modelling to test the impact
of service change
Claire Cordeaux Julie Renfrew Bev Matthews
Executive Director, LTC YoC Commissioning Programme LTC Programme Lead,
Health & Social Care NHS England NHS England
Simul8 Corporation
Questions and discussion
39. www.england.nhs.uk
Using Simulation
Modelling to Test the
Impact of Service
Change
Claire Cordeaux, Executive Director,
Health and Social Care, Simul8 Corporation
Julie Renfrew, LTC year of care
commissioning programme, NHS England
Beverley Matthews, LTC Programme
Lead, NHS England
Thursday 17 December 2015
Long Term Conditions
Improvement Programme