Tony Hindle

Specialty Location Decisions in the Reformed NHS: A Case Study

A soft systems approach, largely based on soft systems methodology, was used to steer a study (completed in 1996) of the National Health Service contracting process. It led to action research projects on a number of related issues. One such area that emerged very strongly concerns service rationalization and service planning, and in particular the location of ‘small’ specialties. A Trust-based study involving patient flow modelling demonstrates the form these problems can take within the internal market and highlights the challenge they make to the contracting process or the new primary care group based commissioning process if they are to be resolved in a rational manner.

Resource Allocation Modelling for Home-Based Health and Social Care Services in Areas Having Differential Population Density Levels: A Case Study in Northern Ireland

This project arose from deliberations within the Department of Health and Social Services (DHSS) in Northern Ireland concerning the acceptability of the revenue resource allocation methodology they were using. One problem with the method being used had been the absence of a component that adequately reflected the relative costs associated with the differential population densities of the four health boards into which the Province is divided. This study investigates a particular element of this issue, viz differences in the travelling distances and times of those health and social service professionals who provide visiting services to patients in their own homes. A modelling approach has been developed and used in conjunction with a comprehensive spatial and geographical information system for Northern Ireland. An important outcome of the study has been estimates of the targets that should be set for the annual health and social care travelling distances and times per head of population in the boards, for a range of home-based services. Also, the project has contributed to decisions made by the DHSS in Northern Ireland concerning the annual financial compensations required by boards for costs associated with their relative population densities.

Modelling and assessing local area differences in road casualties: a case study in England

The context of this research is the governmental targeting of road casualty reductions in England. Local authorities have a major role to play in achieving such targets and this research explores the relationships between road casualties and local authority characteristics such as population, road networks, traffic, and geography. Regression models are identified for types of road casualty to provide local area expectations against which observed numbers can be compared. A number of issues are identified that raise concerns about the current methods adopted for assessing road safety performances and about the implementation of this approach at local levels. These issues include the large impact on assessments of judgements of casualty severity and of estimates of starting point casualties when estimating reductions over time. This study leads to recommendations for ways in which current approaches to road casualty appraisal might be improved.

Developing GP monitoring systems guided by a soft systems approach.

This paper describes a selected aspect of a research project concerned with ‘contracts and competition’ in the recently reformed National Health Service. The particular feature highlighted in this paper is the central role played by the general practitioners in the health service as principal sources of the demands made on provider units (particularly hospitals) and, hence, critical determinants of volumes and costs in contracting. A practical outcome of the research has been the development of GP monitoring systems to be used by provider units particularly in the context of marketing-led referral expectations. The approach used to highlight areas of potential GP contract management and monitoring improvements has been a development of soft systems methodology.

The relative accessibility for health districts to regionally supplied specialist services.

This paper describes a study carried out in the North Western Health Region of England where it is policy to provide access to regionally supplied specialist services on an equal basis to all component Health Districts. The results, however, suggest substantial differences in uptake depending on the proximity of the District of residence of the patient to the location of such specialist service. Throwing light on this phenomenon proved difficult because many important Regional services are hard to disentangle from the ‘normal’ District services with which they are organisationally linked. Also diagnostic classification schemes do not always provide a clear indication of those patients who require the super-specialist service.

Geographical modelling of patient episode flows and hospital catchment populations: a case study in Northern Ireland

This paper describes the development of a decision support framework, which contributed to the strategic management of radical changes in hospital services in Northern Ireland. The approach employed geographical modelling to estimate patient episode flow effects between geographical areas and hospitals under different hospital configurations. Such effects are central to the evaluation of key strategic issues such as catchment population characteristics (and the funding of such), capacity planning and achievement of access/travel time targets. The approach is illustrated with an evaluation of a new-build hospital development in a region within the Province. With respect to the modelling of episode flows, this research has investigated proximity to the nearest ‘appropriate’ hospital as a primary explanatory factor determining hospital choice and has explored ways of defining and quantifying appropriateness.

A statistical study of factors influencing outpatient service in health districts.

This paper describes a statistical study within NHS health districts, using routinely available data, of the supply of outpatient services, the demands made on these services and the resulting balance of supply and demand. Indicators of supply have been investigated which aim to reflect the resources available within a district for outpatient services and indicators of demand have been studied which link to the number of general practitioners who are considered likely to make use of the services provided. Some preliminary analysis is attempted of relationships between the observed balance of supply and demand and the predictions based on the statistical models developed.