Scottish bed crisis leads to review on planning services

BMJ 1996; 312 doi: (Published 27 January 1996) Cite this as: BMJ 1996;312:204

A review of planning assumptions for acute medical services is being conducted in Scotland after the cancellation of hundreds of scheduled operations in recent weeks as hospitals have been forced to keep beds free for emergency cases. The influenza outbreak coupled with the effects of extreme winter weather resulted in medical admissions soaring throughout the country. Hospitals in Edinburgh, Glasgow, Dundee, Falkirk, and Stirling all had to cancel non-urgent admissions.

Doctors, health unions, and opposition politicians complained that hospitals had been left with too few beds to cope with such a situation and called for a moratorium on any further reductions pending a reassessment of long term needs.

The Scottish Secretary, Michael Forsyth, saw the problems at first hand during a visit to one of the worst affected hospitals, the Edinburgh Royal Infirmary, where medical admissions were running at 50-60 a day compared with a normal average of between 30 and 40.

He announced the review of acute services later that day after a series of hastily convened meetings with representatives of the BMA, the Royal College of Nursing, and hospital chief executives.

Mr Forsyth said that exceptional difficulties had contributed to the problems, and he rejected claims that the problems were due to cuts in the number of beds. He said, however, that he wanted to ensure that hospitals were capable of coping with high levels of demand for short term acute services.

The review has been welcomed by health service staff, some of whom are convinced that more beds are needed. Dr Keith Little, consultant in charge of the accident and emergency unit at the Edinburgh Royal Infirmary, said: “If hospitals are working to maximum efficiency for acute beds and there is an unexpected bulge, there is nowhere else to put the patients. The strategy needs to be addressed. The theory of progressively cutting beds is flawed—we need more acute beds.”

The number of acute beds in Scotland has fallen from 19922 in 1981 to 15160 last year, and the Scottish Office has told the health boards to plan further reductions, which could see the total number fall to around 12000 by the end of the decade.—BRYAN CHRISTIE, health correspondent, Scotsman

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