Intended for healthcare professionals

Letters

Turning round NHS deficits: Who says there are surplus hospital beds?

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7537.363-a (Published 09 February 2006) Cite this as: BMJ 2006;332:363

Evidence suggests capacity is badly managed...

It is easy to confuse the symptoms of bad organisation with the
symptoms of a lack of capacity which is why Peter Davies feels there are
too few beds. But his consclusion is wrong: there is plenty of evidence
that the (genuine) problem of finding a bed when you need it is caused by
bad organisation and not by a fundamental lack of capacity.

Here are some simple examples.

The Audit Commission first pointed out several years ago, the length
of stay in a bed depends strongly on the day of the week the patient
arrives.[1] This is mostly because many hospitals don't do much discharging
at weekends, so patients stay longer then they should for no clinical
reason. Hospitals who fix this can gain about 10% extra capacity.

My own work on daily patterns of arrival and discharge suggests big
gains for those hospitals who manage the timing of arrival and discharge
(hospitals can't control emergency admissions, but they can control most
discharge and elective admission times). Discharging in the morning and
moving some admissions to the afternoon can give 15% more beds avavilable
at lunchtime (often the worst time to find a bed). Most hospitals appear
to do the opposite creating a crisis in bed occupancy just when the beds
are most needed.

Perhaps the most remarkable thing is that many hospitals have no
reliable data about when their patients are admitted and discharged. So
they can't even hope to analyse whether organising the beds a little
differently would solve problems in availability.

Hospitals who choose not to bother managing the controllable
processes around discharge and admission have no grounds for complaining
about the lack of available beds. The real problem is not capacity it is
poor organisation.

Competing interests:
Management Consultant working in health.

[1] Audit Commission. Bed management. London: Audit Commission, 2003. www.audit-commission.gov.uk/reports/AC-REPORT.asp?CatID=PRESS-CENTRE&fro... (accessed 14 Feb 2006).

Competing interests: No competing interests

14 February 2006
stephen black
Management Consultant
london sw1w 9sr