BMA warns of bed crisis in the NHS

BMJ 1996; 312 doi: (Published 20 January 1996) Cite this as: BMJ 1996;312:139

The BMA has warned that unless urgent action is taken there will be a “severe and prolonged bed crisis in the acute sector of the NHS.” The association has called on the health secretary and the ministers responsible for Scotland, Wales, and Northern Ireland to take action to rectify the crisis. This follows reports in the press and the experience of many BMA council members of the increasing difficulties in finding short stay beds.

The BMA chairman, Dr Sandy Macara, said that there was a “potentially lethal cocktail of problems,” the main one being lack of flexibility to cope with sudden, increased demands. The number of short stay beds had been reduced by 2.8% in England between 1984 and 1995, to save money and because of the increase in day surgery, shorter hospital stays, and the expected increase in community care services. Some wards had had to be closed because of staff shortages, particularly of nurses, who were increasingly reporting sick.

The increased number of emergency admissions—on average 2-3% a year—had also reduced the number of beds available for short stay admission, and many beds have been blocked by elderly and mentally ill people, often because of the lack of community care facilities.

Dr Macara criticised the waiting list initiative, which had led to resources being diverted to non-urgent cases and had distorted clinical priorities.

He called for more resources to reopen beds and suggested that in the short term the waiting lists for elective treatments could be allowed to grow. The internal market, Dr Macara said, had led to hospitals competing instead of cooperating when there was a crisis. With decisions being pushed down to trusts there was “no longer any central lever to ensure that money goes where it is needed.”

Dr Macara emphasised that the problem affected general practitioners as well; their workload had risen and they were increasingly frustrated at not being able to admit patients. Doctors were spending hours trying to find beds for patients, and this took them away from treating other people. It showed “a complete lack of understanding” when the health secretary said that more work could be done in primary care.

Some doctors blame the contracting system, with trusts running out of money. Queen's Medical Centre, Nottingham, is underfunded by pounds sterling2m because it has exceeded its contracts. According to Mr Brian Hopkinson, a consultant surgeon, all surgical planned procedures were stopped for at least three weeks, from 18 December to 8 January. On the day that this ban was lifted one consultant had 95 general medical emergency admissions.

A general physician at King George Hospital, Ilford, Dr Joy Edelman, said that it was not unusual for 20 patients to spend the night on trolleys waiting for beds. Sometimes it was two days before a bed could be found.

Dr Ellie O'Sullivan, medical director at Queen Mary's Hospital, Roehampton, and five other directors wrote to the South Thames regional chairman about the position in their hospitals. One hospital reported a 22% increase in admissions via the accident and emergency department compared with this time last year.

The Royal London and Homerton Hospitals have reported a 13% increase in emergency admissions and the admission of more elderly people compared with this time last year.

The opposition health spokesperson, Ms Harriet Harman, accused the government of diverting resources into bureaucracy. “The fundamental principle of the NHS is being threatened,” she said, “with cuts in beds, lowering in staff morale, and intensive care beds not available when needed.”

The health minister, Mr Gerald Malone, denied that the internal market was causing the problems and said that overall the number of emergency admissions had gone down by 2% since 1990. But he has written to trust and health authority chairmen telling them that they can lift the limit on recruiting staff grade doctors to accident and emergency departments. The NHS Executive has issued guidance on making accident and emergency posts more attractive to junior doctors and the chief medical officer is planning a review of emergency care services outside hospital (see also p 188).—LINDA BEECHAM, BMJ

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