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Lanner Group’s visual interactive simulation software WITNESS has been used in the NHS to model bed occupancy. This case study was published following a WITNESS project carried out in Calderdale and Huddersfield NHS Trust. This piece of work formed part of a larger project (The PRISM Project) researching the use of simulation in HealthCare.


At Calderdale and Huddersfield NHS Trust, agreement was reached for a major redevelopment of hospital facilities. These changes involve replacement of the existing three hospital sites in Halifax with a new general hospital. A budget of £36 million was estimated for this project, which was already in advanced planning stages.

One important aspect identified in the redevelopment programme for Calderdale is the redirection of resources from hospitals to community care facilities. A report published by West Yorkshire Health Authority (1995) states that:

“New community-based services will be provided to enable the residents of Calderdale to receive as much care as possible at home or close to home. This will reduce the reliance on hospital services and there will therefore be a managed transfer of resources away from the hospital sector and into the community health services.”

Elderly Care

In common with most hospitals, the provision of elderly care within Calderdale’s hospitals constitutes a major element of the overall service provision. In terms of hospital bed use, for instance, elderly care patient’s accounts for a significant proportion (around 28 %) of the total bed use. Any reduction in this bed use would therefore have a significant impact on the overall hospital requirement.

Many now consider that a proportion of elderly care services currently provided in hospitals can more appropriately be provided elsewhere. Whilst hospitals are clearly suited to the provision of acute care of such patients; other aspects of service such as rehabilitation, respite, continuing and terminal care are arguably more effectively and efficiently provided by other means. Residential and Nursing homes, for example, provide accommodation that is often more suited to the needs of such patients. Alternatively it is often possible to establish managed care plans which support elderly patients to live in their own homes. Such alternatives are often preferred by the patients themselves whilst at the same time providing a more efficient use of resources.

Any reallocation of care services from hospitals to alternatives such as those described above is likely to impact most directly on the recorded length of stays for elderly care patients. Rehabilitation care, for example, if transferred from existing hospitals to units in the community, would likely result in a dramatic reduction in the recorded LoS for elderly care patients. Given this it is important to model the effects of any changes in the LoS distribution profile for elderly care in order to assess the likely impact on bed occupancy within the hospital.

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