Intended for healthcare professionals


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

BMJ 2006; 332 doi: (Published 09 February 2006) Cite this as: BMJ 2006;332:363

Reply to Stephen Black

Stephen Black raises an interesting point. Is what I observe as a
practising doctor a reflection of lack of capacity? Or is it a reflection
of poor management of the bed complement of the NHS?

Firstly I am going to generalise my original observation. There have
been problems with bed occupancy levels and availability of acute beds for
at least the last 19 years that I have directly observed. (I started as a
clinical student in Leeds in 1986 and graduated in 1989). I suspect the
problems have been there far longer than this. These problems have been
obvious in every hospital and speciality I have worked in, and have been
obvious to me as a GP when trying to get patients into the hospitals. In
other words these problems seem to be pervasive in time and place. I also
think most of my colleagues would report similar observations from their
hospitals and GP surgeries.

Boaden (1) reports that the problem with bed occupancy may be worse
than thought, especially with the lunchtime bulge. Bagust et al (2) show
the need for some spare capacity if emergency admissions are to be managed
well. Alan Milburn was arguing for extra hospital beds in 2000. (3)
Despite his promises the bed complement was still being cut. (4)

The problems with high bed occupancy rates have been clear to many
intelligent and well trained doctors, nurses, managers, management
consultants, civil servants and politicians for many years. Much has been
thought about and tried to solve this problem with little success. Either
we are collectively blind to the solution, or there is a genuine lack of
capacity to meet the needs of the population for treatment.

Whilst there may be some improvement to be gained from improved bed
management (5) I still suspect that the real problem is a lack of

1.Boaden, R (1999) Occupancy probably already higher than thought 17
July 1999

2. Bagust A, Place M, Posnett J. (1999) Dynamics of bed use in
accommodating emergency admissions: stochastic simulation model. BMJ
[Abstract/Free Full Text]

3. Jones, J (2000) Milburn promises more hospital beds
BMJ 2000;321:1246 ( 18 November )

4. Dunnigan, M and Pollock, A (2003) Downsizing of acute inpatient
beds associated with private finance initiative: Scotland's case study
BMJ 2003;326:905 ( 26 April )

5. Proudlove, N.C., Gordon K. and Boaden, R (2003)
Can good bed management solve the overcrowding in accident and emergency

Competing interests:
None declared

Competing interests: No competing interests

16 February 2006
Peter G. Davies
Keighley Road Surgery, Illingworth, Halifax, HX2 9LL