Endoscopy Services


Gastrointestinal endoscopy describes a set of diagnostic tests for investigating the lining of the stomach, oesophagus and bowel for cancer or other conditions.It is a diagnostic service under significant pressure, and with a new NHS diagnostic metric to be introduced in 2020, capacity planning is an urgent local requirement.

Discrete-event simulation (DES) is a suitable method for supporting capacity planning of healthcare services, using queues and servers to model a system. A formal model supports decision-making by allowing service planners to investigate what is likely to happen if they take certain actions. Static demand inputs are commonly used in DES models, however demand for endoscopy services is increasing year-on-year at a national level, suggesting that capacity planningfor this service will benefit from taking account of future changes in demand over time.

Torbay is an area of the UK which is popular for retirement, with a significantly higher proportion of elderly people in its population compared with many other parts of the UK. Endoscopic investigation is age-related, with the majority of those needing the service agedover fifty years. Forecasting demand for endoscopy services should account for local population profile changes over time. The Office of National Statistics releases biennial population projections, and using these at the CCG level can provide a baseline projection for demand for a service.

However other factors contribute to demand for endoscopy, in particular changes to policy to improve early cancer diagnosis.With early diagnosis continuing to be a high priority for the Department of Health, future policy changes are expected to continue to have a similar impact on demand as past changes. Adjusting historical demand for each procedure by local Torbay demographic change created a set of demand forecasts over a ten-year period that were then used as input variables in a DES model.

A reliable health forecast is important to enhance preventive health service delivery, and support decision-making for optimised allocation of scare resources. Efficiency improvements in healthcare can be gained by improving the match between demand and capacity, and no single model can adequately capture both dimensions. Future work will develop the DES model to support planning of this vital service, which continues to be under increasing pressure to deliver more services to a greater proportion of a growing population.


Harper, A., Mustafee, N., and Feeney, M. “A Hybrid Approach Using Forecasting and Discrete-Event Simulation for Endoscopy Services.” InProceedings of the 2017 Winter Simulation Conference, December 3-6, Las Vegas, NV. IEEE (accepted).