Modelling the impact of Covid-19 recovery on community health services

While there has been significant research addressing the pressures facing secondary care during the COVID-19 pandemic, less attention has been paid to downstream services in the community which have also been challenged in meeting demand. This study aims to estimate the optimal capacity requirements for community services within a major healthcare system in England, at a time when considerable uncertainty remained regarding vaccination uptake and the easing of societal restrictions. Demand for ‘Discharge to Assess’ community services was projected through an epidemiological model (COVID-19 demand) and public mobility (non-COVID-19 demand). These projections were used as inputs to a purpose-built and open-source set of discrete-time simulation models that capture patient flow through bedded and home-based community services. Eight different scenarios were developed in order to determine cost-optimal capacity requirements from mid-May until end of 2021. The baseline assumed 90% vaccination uptake and an end to societal restrictions on 21 June 2021. Alternative hypothetical scenarios considered a 75% vaccination uptake, a 2-month delay to the lifting of societal restrictions, and a change from current to aspirational length of stay. Modelling suggests that a reduced vaccination uptake would result in a significant peak in capacity requirements for autumn 2021. Although a delay of two months to an end to societal restrictions didn’t significantly affect the cost-optimal capacities, aspirational lengths of stay translated into 20% to 35% lower cost-optimal capacities, and lower vaccination uptake led to increases of approximately 10%.