An interactive simulation in the health service

There is an unmet demand for the treatment of irreversible kidney failure, particularly in the older age groups. A model of the treatment system was built to explore the implications of meeting the demand, giving different priorities to the available treatments and changing the balance between home and hospital. This discrete event simulation, developed in the Wessex Region, describes the system realistically, including resource use and constraints, the arrival of kidneys for transplantation and the matching of donors with recipients. It is written in Pascal on an Apple II computer and uses shadow entities to describe the survival of patients on each type of treatment. The model was validated with techniques which included the use of a tabular display while the simulation was running. The model has proved to be easy to use and robust both to different data requirements and extreme policy changes. The techniques developed have more general application in the Health Service context.