01 / Standing orders
Begin with the inherited service.
- Choose Campaign Mode. It includes the appointment brief, optional first-quarter guidance and fixed incidents. Free Play skips the brief and can disable shocks.
- Choose a starting file. Under Strain is the reference opening and the recommended first game.
- Start in Situation. Read the live priority and inherited brief before changing anything.
- Find the bind in Flow. A pathway clears only when every required stage has enough capacity.
- Check Operations and Finance together. Funding without staff, diagnostics, theatres or beds can under-deliver.
- Press Play. Time advances weekly. Pause whenever you need to read or change course.
- Save deliberately. Use manual slots for milestones and download a backup before an experiment you may want to undo.
02 / Starting files
Three files. One physical service.
Difficulty changes the available Treasury grant and inherited acute and mental-health queues. Physical capacity, service commitments and incident odds do not secretly change.
Easier
New Era
105% of the reference grant, smaller inherited queues and opening headroom.
Recommended first game
Under Strain
The £204.945bn reference grant and published reference waiting stocks. The opening plan is balanced.
Hard
State of Peril
95% of the reference grant, larger inherited queues and an opening projected deficit. A diagnostic challenge, not a promised win.
03 / The desks
Seven command desks.
Situation
Reports, advisers, incidents and urgent decisions. Start here when the service changes.
Flow
Patient pathways and the current binding constraint. Follow the queue to the stage holding it back.
Operations
Workforce, ambulance, diagnostics, theatres, beds and estate—the physical delivery machine.
Finance
Grant, commitments, deficit, debt and Treasury controls. A funded promise is not always delivered capacity.
Outcomes
Absolute harm, population health and equity. Comparative results never replace the service’s real record.
Programmes
Commissioned services, prevention and access arrangements, including the consequences of charges.
Transform
Multi-year capabilities with prerequisites, delivery ramps and delayed system effects.
04 / The clock
The clock is part of the game.
The model moves in weekly steps. Workforce training, estate and transformation take time; immediate budget changes do not create immediate nurses, theatres or beds.
Holding course is a plan. Pause to read, run at one week every two seconds or fast-forward at one week per second. Reviews and major reports pause the clock when a decision needs your attention.
Keyboard and display controls
- SpacePlays or pauses while preserving the selected pace.
- Tab / Shift+TabMove through controls.
- Arrow keysMove across tab lists.
- EscapeCloses optional dialogs.
Settings include interface motion, scale, density, contrast and display currency.
05 / Saves
Your command file stays with you.
The Recovery autosave updates as the tenure advances. Three manual slots support named milestones. Saves are stored in the current browser on this domain; they do not automatically appear on another device or browser.
Download a portable .nts-save.json backup from the Load File screen. Import checks the file before replacing a chosen slot and asks before overwriting an existing save.
06 / Terms and reports
Four terms become one record.
A full campaign lasts twenty years across four five-year terms. Each term report records the service position, the decisions made and the difference from the inherited-course comparison. The final handover judges what remains after the last week—not just the best moment along the way.
Campaign incidents are fixed so a repeated tenure can be compared. Free Play can make shocks optional when you want to isolate a system or test a plan.