The NHS in the simulator

BMJ 2009; 339 doi: (Published 03 December 2009) Cite this as: BMJ 2009;339:b4868
  1. Martin McShane, director of strategic planning 1,
  2. Richard Smith, director2
  1. 1NHS Lincolnshire, Bracebridge Heath, Lincoln LN4 2HN
  2. 2UnitedHealth Chronic Disease Initiative, London SW4 0LD
  1. Correspondence to: R Smith: richardswsmith{at}

    NHS funding is set to fall in real terms but it is unclear how the system will cope. Martin McShane and Richard Smith describe their experience of a simulation exercise designed to find out

    How might you or your organisation respond to a severe financial crisis? One option is to wait and see what happens, hoping it won’t be that bad. A second option is to guess what is likely to happen and act accordingly, but it’s hard to predict what might happen in highly complex systems like the National Health Service. A third option is to run a simulation, and that’s what the King’s Fund chose to do at the end of July.

    Simulation feels real

    The essence of a simulation is that you assemble all the players in a system and ask them to respond to a given set of circumstances by negotiating with each other as if for real. People play something close to the roles they have in real life and have to follow the usual legal, organisational, and professional rules. The circumstances reflect reality and are drawn up after consultation with well informed insiders. After the “game,” the players reflect on what happened and the lessons learnt.

    We participated in the simulation, and we wrote our first draft of this article 16 hours after staggering out of the event with our heads reeling. But you won’t be reading this until after the results of the simulation are published in December with lessons for all stakeholders.1 The published results will, we are sure, achieve greater clarity than we are able to do, but there may be something extra to learn from a rough and raw account—rather as letters from soldiers in the trenches of the first world war add to the accounts of historians. It’s also probably true …

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