Sunday, 11 May 2008

Who needs beds?

The imminent loss of 5,000 Oncology beds has been hitting the news this weekend. Apparently in order to improve our radiotherapy and chemotherapy services, these beds will need to be cut to fund the investment. It's all part of the great Darzi review that pledges to force reform upon the whole country in its uniquely undemocratic manner.

As has been pointed out to me by the ever aware A&E charge nurse "the UK population has grown by 17% since 1951 while the number of NHS beds has fallen by 40% since 1959 - we have one of the lowest bed per 1000 patients in Western Europe: 3.3 compared to 6 beds in Germany, to cite just one example."

Certainly keeping some people out of hospital is a good thing, however many of the DoH's reforms have wasted money in ineffectively trying to keep people out of hospital and in forcing patients out of hospital when it is clearly the most appropriate place for them to be. I also heard in the news that the budget for elderly care is to be trimmed by several billion over the forthcoming years, another example of the lack of joined up thinking in government, as with an ageing population and an increasing demand for care for the elderly, these short sighted cuts will only result in yet more inefficiency with old people blocking acute hospital beds as there is nowhere else for them to go.

The cut in Oncology beds is bizarre, as anecdotally I have heard of cases of there being such a shortage of beds locally that sick Oncology patients are having to be treated as in patients in waiting rooms and day rooms. Oncology patients get sick quick, radiotherapy and chemotherapy have some pretty serious side effects such as neutropenic sepsis, and these cannot be adequately managed in 'cottage hospitals' as the government seems to think. The Darzi philosophy seems to be all about cutting services and beds, while shifting sick patients into the community to save cash, I personally don't recognise this a progress.

The national bed shortage and near 100% bed occupancy rates have so many negative knock on effects in terms of patient care and efficiency that I could bore you with them all day . Around the country numerous operations are needlessly being cancelled because there are no beds in which to admit patients for their stay, meaning that surgeons, anaesthetists and theatre staff are often left to twiddle their thumbs in empty theatres because of this knock on inefficiency. Patients are frequently not cared for in an appropriate ward to suit their particular illness, as bed shortages mean that any bed sometimes has to do; this can sometimes be deeply inappropriate with adults being cared for on paediatric wards, and it can also result in significant morbidity and mortality as patients may be significant distances from their medical staff, while their specialist nursing staff may well not be familiar with the particulars of dealing with another specialities' patients, surgical nurses looking after oncology patients for example. The link between high bed occupancy rates and hospital acquired infection is for another day.

Overall the beds are cut and the inefficiency increases, economies of scale are ignored as the short sighted penny pinching results in the flushing of bank notes down the toilet on a rather regular basis. It makes me weep to see stooges like Darzi pretending that these reforms are in the best interests of patients up and down the country. If my mother was lumped on an orthopaedic ward with her neutropenic sepsis I would not see this as progress, I just wonder why Ara Darzi is so happy with this dismal state of affairs.


Anonymous said...

"surgeons, anaesthetists and theatre staff are often left to twiddle their thumbs in empty theatres"

Well, he's getting rid of them as well! And the theatres!

It's a really sorry state of affairs

the a&e charge nurse said...

The PFIs seem to have compounded the reduction in capacity even further, since they all seem to have been designed with fewer beds ?

Neutropenic sepis - it's not just a medical oncology ward that is required, but a side room to boot.

I have seen grown bed managers weep after a run of patients who could not be admitted to a bay (perhaps because they need negative pressure facilities, or isolating because of diarrhoea, or MRSA, etc, etc).

I agree entirely that we should look after people at home (if it is safe to do so) I would certainly prefer it if it was my family.
But look at the mess psychiatry got itself into following "care in the community" - bed occupancy rates in London are now hitting 113% !!!
Now how is that meant to help patients ?

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