Intended for healthcare professionals


Turning around NHS deficits

BMJ 2006; 332 doi: (Published 19 January 2006) Cite this as: BMJ 2006;332:131

Who says there are surplus hospital beds?

Ham's editorial (1) is a clear summary of the N.H.S.’s current
financial plight. However in his fourth paragraph he (whether wittingly or
unwittingly) illustrates a gulf between health economic and medical

There appears to be a specific belief in health economic circles that
there is overprovision of beds in acute hospital settings. As a doctor I
do not share this belief.

When I admit acutely ill patients I see no evidence of oversupply of
acute beds. Instead I am often asked to delay the admission or deflect it
to A+E first. The psychiatrist tells me that he can only admit patients if
they are homicidal or suicidal. The phenomenon known as bed blocking does
not speak of overprovision of care in hospital, intermediate or
residential care settings.

All these examples speak of lack. I challenge Professor Ham to show
me which patient specifically is currently being overprovided for in any
NHS bed.

Roemer’s Law that a bed created is a bed filled is a reflection of
the fact that there is still much unmet need for healthcare. Indeed one of
the commonest research findings is that “this disease is under treated or
diagnosed in primary or secondary care and more time/money/education
should be put into it.” This unmet need is a consequence of the icebergs
of symptoms and disease. (2, 3)

The NHS should be gearing up to meet unmet need. Instead it is
currently being downsized and fragmented, whilst expectations of it are
being upsized. The attempt by the government to sustain it solely from
taxation is falling apart. In 2002 I asked what exactly would be bought by
increased NHS funding. (4) In 2006 we can see that little has been bought,
and much wasted.

1. Ham, C (2006) Turning around NHS deficits BMJ 332; 131-2

2. Hannay, D.R. (1979) The symptom iceberg A study in community health.
London: Routledge and Kegan Paul

3. Last, J (1963) The Iceberg: completing the clinical picture in general
practice Lancet ii 28-31

4. Davies, P (2002) What exactly is being bought with this gold? BMJ 325:

Competing interests:
None declared

Competing interests: No competing interests

27 January 2006
Peter G. Davies
GP Principal,
Keighley Road Surgery, Illingworth, Halifax, HX2 9LL