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NHS in crisis Monday, 17 January, 2000, 12:42 GMT
The beds debate
Edinburgh Royal Infirmary's beds crisis caused a resignation
Bed shortages have taken the brunt of the blame for the problems facing hospitals over the winter period.

But the debate over bed numbers is a complex one, with some arguing that a modern NHS will not need so many general medical beds because of advances in technology.

In the 1960s, there were more than 3,000 hospitals with 550,000 beds between them.

By 1995, there were only 250,000 beds and now there are some 194,000, of which 108,000 are for acute patients.

Some 11.5 million patients were treated in 1997/98 compared with 8.2 million in 1987/88.

But doctors argue that new technology has meant 50% fewer overnight stays in hospital.

Day surgery is growing across the country, with operations such as cataract removals and hernias being dealt with by hospitals without an overnight stay.

Hospital building

Private finance initiatives (PFI) are likely to reduce bed numbers even further, although patient numbers are increasing.

The government has heavily promoted its hospital building programme, which includes an emphasis on PFI.

A 2.5bn PFI programme will build 30 new hospitals over the next few years, with the first PFI hospital expected to be finished by next year.

Dr Brian Potter, Scottish secretary of the British Medical Association, says the initiative could increase the NHS beds crisis.

He says the new PFI Edinburgh Royal Infirmary to be built over the next five years will have significantly fewer beds than the three hospitals it is replacing.

The infirmary, which was in the news recently after its head of A&E resigned because of bed shortages, will have 870 beds.

Dr Potter says the new hospital is expected to have just five opthamology beds, compared with the 24 that now exist in the hospitals marked for closure. It will have just three dermatology beds, compared to the 41 that exist now.

Bed occupancy

But PFI experts say that, without private finance, new hospitals could not be built.

And there is no guarantee that hospitals which were built purely with public finance would not also reduce bed numbers.

Hospitals face pressure to increase the throughput of patients
"There would still be pressure to increase bed occupancy as there is always pressure on efficiency," said Seamus Ward of Public Finance magazine.

But he says private firms, which are normally tied into a 60-year lease with health trusts and generally expect to make their money back within 30 years, may have more reasons for making sure all beds are used to the maximum.

This means fewer beds and a quicker throughput of patients.

According to Age Concern, elderly people are already being discharged before they are ready because of pressure to free up beds and to avoid so-called bed blocking.

In 1996/7 in England, more than 86,000 people aged 75 and over were readmitted to hospital as an emergency within 28 days of discharge.

It admits that part of the reason is due to a growing number of hospital admissions.

But it says cuts in beds are combining with cuts in local authority funding for the elderly.

This has led to care being targeted at the most severely ill at the expense of those who could stay out of hospital if they had the proper support when they were discharged.

One of the reasons for bed shortages is poor co-ordination between health and social services.

Although the situation is improving in many areas with government emphasis on better working relationships, there are still problems finding aftercare for vulnerable people who are fit to leave hospital.

And there are still arguments between health and social services about who should pay for the aftercare offered.

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