The Strategy Unit is embarking on an exciting project with WM ADASS, the Association of Directors of Adult Social Care Services in the West Midlands to explore the challenges facing domiciliary care and the opportunities that exist to transform and improve the service.

Domiciliary care is an essential component of the health and social care system. It supports many thousands of individuals to lead happy and independent lives in their own homes. But the service is under immense pressure. Demand and expectations are rising, recruitment and retention of staff is increasingly difficult and financial constraints are never far away. If domiciliary care is not provided, then the effects are felt not just by those who need the service, but also by a wide range of aligned health and care services: hospital beds become blocked and care home beds are overrun. Failure is untenable, but how can we secure, stabilise and enhance this critical service?

Solutions have been proposed: increasing pay for care staff, improving training and career prospects, quality or outcome-based payments for contractors, additional support to informal carers etc. How might we weigh up these options, to test whether they might work, estimate their costs and impacts and ultimately make the case for sustainable change?

The Strategy Unit will be collaborating with West Midlands ADASS to develop a series of system dynamics models to get a better grip on what the future might hold and how options to address future challenges might perform. System dynamics is an established approach that models the behaviour of complex systems. The models will estimate the changing level of demand for domiciliary care over time, alongside the availability of staff and other resources. The models will provide a safe space for decision makers to explore how a domiciliary care service might behave if key features of the system (e.g., staff pay, contracts with providers etc), were changed.

The Strategy Unit will be supported by Douglas McKelvie, a recognised expert in system dynamics modelling in social care, and Professor Robin Miller, Director of Global Engagement for the College of Social Sciences, at the University of Birmingham.

In the video below, Douglas introduces using an example model to show the potential implications of changes to staff wages and provider commissioning arrangements:


We are running some introductory information sessions about the project via Microsoft Teams on Tuesday 2nd November 10-11am and Tuesday 9th November 2-3pm, these are aimed at participants for the group model building workshops, but we would be happy to share this introduction with a wider audience. If you would like to be invited to one of these sessions or if you would like to find out more about the project, please contact Stacey ( ).