System dynamics used in amending UK Government policy

["Eric Wolstenholme"]

I thought colleagues might like to know that system dynamics has recently
been acknowledged as being very influential in moving amendments to a UK
government Bill.

The Bill in question was a Central Government Community Care (Delayed
Hospital Discharge) Bill. The intention of this Bill was to improve
discharges of patients from hospital by charging a levy on Social Services
Departments in Local Government when these delays occurred. The argument
being that the preparation and delivery of community care packages,
particularly for older people, by Social Services Departments was blocking
beds for the admission to hospital of all kinds of patients.

During September 2002, I led a joint project between Cognitus and OLM
Consulting and created a joint agency model for the Local Government
Association and NHS Confederation in the UK to address the issue. These
organisations lobby Central Government on behalf of Local Government and the
National Health Service respectively.

The model provided evidence that delayed discharges were not simply the
fault of social services, but actually the result of complex and dynamic
interactions between all agencies across the patient pathway concerned. The
model was used at the Labour Conference in the autumn of 2002 to make a case
for more systemic solutions to delayed discharges.

Although the Bill was successfully passed in the House of Commons, it was
rejected by the upper House of Lords who moved amendments to the Bill in
line with the more systemic approach (Lord Clement-Jones, Liberal Democrat
health spokesperson, Hansard, Jan 2003). The extract from Hansard follows:

COMMUNITY CARE (DELAYED DISCHARGES) BILL:
Moving the main amendment, Liberal Democrat health spokesperson Lord
Clement-Jones asked the House to agree that the Bill failed to tackle the
causes of delayed discharges and would create perverse incentives which
would undermine joint working between local authorities and the NHS and
distort priorities for care of elderly people by placing the requirement to
meet discharge targets ahead of measures to avoid hospital admission. He
said that as a result of the Bill and the imposition of fines, social
services will prioritise NHS patients over those in hospices so the former
will be assessed urgently and will benefit from quicker service on home
adaptations. Lord Clement-Jones referred to the unanimous views of both the
voluntary and statutory sectors that the Bill will do massive damage to
joint working and said the sanctions for failure set out in the Bill were
totally one-sided and unfairly shifted the flame for delayed discharge on to
local government. He referred to "ithink", the whole systems approach being
put forward by the Local Government Association, health service managers
and social services directors involving joint local protocols and local
action plans prepared in co-operation.

As a result of the amendment, the progress of the Bill has been halted for a
year to allow more time for consultation. Cognitus and OLM will be
supporting this process with various change agencies.

Eric Wolstenholme 18 March 2003
From: "Eric Wolstenholme" <eric@cognitus.co.uk>