Lack of hospital beds in UK

It is sad that I feel duty bound to use my blog as an author to raise the problems I see with the UK's National Health Service, but where else can one get one's views in the public view? The bloated administration of the NHS is sucking the lifeblood out of the service where administrators with no clinical experience are on six figure salaries. At the same time skilled clinical staff are losing their jobs.

Take for example the reported shortage of hospital beds (BBC article - Nick Triggle). The Government deny there is a shortage, but if you talk to any A& E Matron and you will hear a very different story. Patients are regularly kept waiting because of bed shortages. The hospitals employ "Bed Managers" whose sole job is to chase the clinicians in the hospital wards to discharge patients early.

The problem with hospital beds is that a "bed" has become a unit of accounting in hospitals. The bean counters find it very convenient to work out the "cost of a bed" by taking the total running costs of a hospital ward/unit and dividing it by the number of beds. Don't forget they also impose the "management overhead + PFI costs" into those running costs. It is not just the medicines, doctors, nurses and ward staff. The bean counters then have an easy to use spreadsheet figure called "bed cost". The cost figure gets absorbed into the management mythology and the people using it forget the original components of the cost.

When senior hospital management realise there have/are going to run out of money they'll introduce cost cutting measures. Some bright bean counting spark will say "if we cut 20 beds from the service we'll save a lot of money over five years". As a consequence patients lose access to those beds, but the overhead hospital costs never go away.  Let's be plain about this: A hospital bed only costs about £5,000 When a hospital "closes" a bed, they don't sell the bed to reclaim the money. The hospital still has to pay infrastructure costs, floor rent, the administrators costs are still there, the PFI costs remain.  The action doesn't reduce the number of patients, people still get sick.

The hospital planners/administrators need to get away from the concept of a "bed cost" and use more realistic accounting methods. 

Here's another view of the problems by a Doctor.

Death by attrition - Walk-In Centre

I'm watching the death by attrition of an NHS Walk-In Centre:-

• Buildings closing (scheduled to be demolished quickly after);
• Alternatively buildings given to a GP practice; even though they are a private concern;
• Primary patients directed away without treatment ("Go to your GP or another clinic such as sexual health");
• Any vacant position arbitrarily removed, regardless of the reason for the vacancy.
• Senior nurses bullied and excluded from management meetings to encourage them to leave;
• Senior nurses made redundant;
• Junior nurses told their jobs are being regraded (downwards) with no real consultation;
• Overnight working in A&E (not primary care) imposed regardless of contract;
• Nurses diverted to streaming duties in A&E;
• Nurses joining a union for the first time ever;
• Specialist computer systems for patient consultation records abandoned and no further maintenance paid.
• Services like Emergency Contraception cancelled - "go to another clinic" even though it is closed and the patient would need an appointment. 
• Senior administrators making arbitrary clinical decisions
• Budgets diverted away to other purposes.

All of this happens without consultation with the public and little warning to patients. All that is left is a deskilled shell nominally called a Walk-In Centre where a couple of nurses share a room somewhere in a larger department.  The PCT or Acute Trust claim the Walk-In centre hasn't "closed".

I've now seen this happen in four different locations over the past couple of years. It is a sickening waste of the public money invested in the creating WIC infrastructure and in the cost of building and training a skilled team of nurses. The public are left with no improvement of services as a result and the workload (queues) in the local A&E increase as a consequence.

One point never successfully handled under if retaining the patient records. They are supposed to be maintained safely and accessible for at least 25 years. This is an enormous cost risk, with the nurses dispersed there is no one able to dispute a legal medical claim. It is another consequence of the Lansley blind bull in a china shop leadership.

This happening in many places in the UK..

Edit: 17th April 2012

I recently had a chest infection which needed treatment with antibiotics to help it clear up. I've not troubled my GP for the past 15 years but I was not surprised to find I could not get an appointment until the following Monday (I was phoning on a Wednesday).  The receptionist's advice was to go to A&E dept or to the local Walk-In Centre. The local walk-in centre is one of those which has closed to be replaced by a ghost service located in another GP Surgery. I wasn't working so I drove to the WIC and was seen by a Nurse Practitioner within half an hour during the normal working day.  However I note that the opening hours have been cut down considerably and there is a map on the wall showing the "Catchment Area" street by street, within a radius of one mile. Proper Walk-In Centres do not have catchment areas! They deal with whoever comes through the door

The next closest Walk-in Centre by time of travel was open in December 2012, but it is now closed and the site is a car park.