In public health, the routine use of linear forecasting, which restricts our ability to understand the combined effects of different interventions, demographic changes and wider health determinants, and the lack of reliable estimates for intervention impacts have limited our ability to effectively model population needs. Hence, we adopted system dynamics modelling to forecast health and care needs, assuming no change in population behaviour or determinants, then generated a “Better Health” scenario to simulate the combined impact of thirteen interventions across cohorts defined by age groups and diagnosable conditions, including “no conditions”. Risk factors for the incidence of single conditions, progression toward complex needs and levels of morbidity including frailty were used to create the dynamics of the model. Incidence, prevalence and mortality for each cohort were projected over 25 years with “do nothing” and “Better Health” scenarios. The size of the “no conditions” cohort increased, and the other cohorts decreased in size. The impact of the interventions on life expectancy at birth and healthy life expectancy is significant, adding 5.1 and 5.0 years, respectively. We demonstrate the feasibility, applicability and utility of using system dynamics modelling to develop a robust case for change to invest in prevention that is acceptable to wider partners.

Health checks aim to improve the health of the population by identifying individuals with risk factors earlier and intervening to prevent disease. The role of commissioners is to ensure health checks provide as much benefit as possible for taxpayer funds invested into them. As such, evidence of the potential impacts of different commissioning choices is beneficial in this decision-making process. System dynamics modelling can be used to provide this evidence by modelling the health check programme using a pre-existing cohort model of a given population. This modelling considers local data, literature findings, and stakeholder views, from which nine different scenarios of a local health check programme have been tested. These scenarios found that extending the duration of health checks to 20 years and improving treatment uptake for those with high blood pressure or high cholesterol reduced rates of cardiovascular disease, improved healthy life expectancy and reduced years lived in ill health. In contrast, improving attendance in the most deprived quintile of the population made very little change to the health of the population overall, although a larger effect was observed in the most deprived areas. These findings helped guide local commissioning decisions by showing the long-term impact of different health check scenarios.

England’s population is living longer, a sign of progress and better health, but adult social care (ASC) services must adapt to support a growing number of older residents, who may need help to remain independent, safe, and well. Kent County Council (KCC), in South East England, projects a 28% and 53% increase in its residents aged 65+ and 85+, respectively, over the next decade. This study aimed to inform the development of KCC’s ASC Prevention Framework using a System Dynamics Modelling (SDM) approach to evaluate the impact of preventive interventions on ASC demand and expenditure. Using linked local health and social care data and the Johns Hopkins ACG® tool, the 1.3 million adult population was stratified into Patient Needs Groups. Analyses showed that higher ASC costs were associated with being older females, living alone, deprivation, and frailty-related indicators such as dementia, history of falls, etc. Around 28% of older adults aged 65+ accounted for 80% of ASC costs within that cohort, and related scenario testing projected a 48% rise in ASC costs over 10 years without interventions, moderated to 33% with targeted prevention. These findings demonstrate the value of integrated data and modelling to inform strategic, prevention-focused ASC planning.

Background: With the SARS-CoV-2 pandemic gripping most of the globe, healthcare and economic recovery strategies are being explored currently as a matter of urgency. The underpinning rationale of this paper is that we believe that health and care services are provided locally, therefore, local implications of national policy need to be reflected when informing national responses to the SARS-CoV-2 pandemic. Methods: We adopted the assumptions underlying the United Kingdom government’s national epidemiological model which influences the national policy response to the SARS-CoV-2 pandemic. We used these in a local context and show projections in terms of presentations of symptomatic patients differ in a variety of settings. Setting: North of England, United Kingdom, population modelled at four local constituent levels which aggregated gives a total population of 3.2m . Results: We clearly demonstrate that there is significant difference in the way the national modelling outputs are replicated at local levels. Specifically, in terms of projected increased levels of demand for services on the local health and care systems. Conclusions: We present significant evidence of differing timelines specifically in terms of subsequent projected peak demands. Additionally, it clearly indicates varying levels of such demand throughout the four modelled localities. These idiosyncrasies are ‘masked’ by both regional and national approaches to modelling. We urge readers to ensure that any national policy is appropriately adopted through the use of complementary bottom up approach, to suit local health and care systems. Finally, we share our methodology to ensure other professionals could replicate this study elsewhere.