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Monday, 8 December 2008

Some remedies to a lack of beds of in Welsh hospitals

The recent situation of a lack of beds across hospitals in South East Wales I have to say, was not entirely unexpected. BMA Cymru Wales did warn that a reduction in bed numbers would lead to an in-balance in capacity. We need to stop cutting bed numbers and get back to a situation of sensible bed occupancy rates. I understand hospitals are currently running at 82% rates, although I’ve been told in some Trusts it’s even higher than that, at over 90%. This leaves no room for manoeuvre, so hospitals are then unable to cope with any peaks in demand, which is particularly acute in Winter. It’s creating problems which could be anticipated. There really is no need to have such high bed occupancy rates. Any that reach over 75% can lead to an increased risk of hospital acquired infections such as MRSA and discharging patients too early to try and free up beds, merely results in those patients being re-admitted, creating a false bed occupancy economy.

More focus is needed on making inroads in transfers of care. Small differences have been made, but statistics highlight how managers are unable to pin-point the obstacles to discharging patients. I think a taskforce is needed to look into the appropriate care environment and a case by case analysis of the obstacles when trying to free up beds. If we could make just a 10% difference, that would equate to the freeing up of 50 beds.

Stopping people from coming into hospital unnecessarily by developing primary care services more, would be another way to address the problem. Providing these services closer to patients’ homes when appropriate, could ease pressure on hospitals. I know there is a desire from the WAG to pursue this in the current NHS reforms, but it is difficult to see how they will be completed in a speedy fashion, especially when there seems to be a lack of development in primary care, especially with regard to premises not being invested in. How on earth are we going to address the expansion of staff needed for the changes in primary care, if we don’t have anywhere to put them?

The Welsh Ambulance service needs to be considered in all of this too. Is this being appropriately resourced, so that it can operate to best effect? The service has a huge potential to be able to deliver alternative care models and avoid having to take everyone who rings 999, automatically to a hospital.

There is a definite requirement to streamline and simplify how we access unscheduled care. Patients are confused by the pathways they need to take. The DECs project was established to address this. But it needs to be moving quicker, so patients are seen at the right place and at the right time. At the moment patients have a vast array of options, and go for what they think is the quickest and easiest, a trip to A&E.

Ultimately, health professionals, working on the frontline of the NHS everyday, need to be listened to. They have the solutions and unless they’re involved in intricate, high-level decisions with managers, these recent problems seen in South East Wales, will worsen and spread.

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