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Wednesday, 22 April 2009

Pressures on NHS bed risks patient safety

Today, we’re highlighting the dangers of cramming patients onto hospital wards, at the same time as the number of beds on wards, are falling.

Because we’re so concerned, we’ve just held a media briefing with Dr Andrew Dearden, Chair of Welsh Council and Dr Stefan Coghlan, Chair of the BMA’s Welsh Consultants Committee.

Figures show that over a ten year period (1997-98 to 2007-08) the total number of NHS beds in Wales fell by nearly two thousand. But, in that time the percentage bed occupancy increased from 78.7% to 82.8%1, which has led to our growing worry for the safety of patients.

Dr Coghlan outlined in the briefing how the NHS is being pushed to breaking point with more patients being treated and despite managerial efforts to reduce the time that patients spend in hospital, the average length of stays, is actually increasing, as the number of beds available for them, is shrinking. This is putting an intolerable strain on staff and causing a great deal of stress and confusion to patients. We certainly wouldn’t be able to cope in a crisis. It is just unsustainable.

The situation has been getting worse during the first few months of this year. A worrying combination of unprecedented emergency admissions, more planned surgery to meet access 2009 targets and so called efficiency savings with pressure to balance the books by the end of the financial year has resulted in unacceptable bed pressures. NHS managers have been holding crisis meetings on a daily basis about where to put patients. We seem to be getting to a point where it’s a case of ‘any bed will do’.

“Hot-bedding” where patients are moved around wards as beds become free appears to be a worrying trend too. Three or more patients could have been in the same bed, on the same day. This constant swapping can cause real confusion and distress, particularly for more elderly patients, who end up not knowing where on earth they are. This makes it very difficult for families visiting, to locate their loved ones, even for doctors to find their own patients. It may not be the best use of a consultant’s time, trying to track down patients and we have heard instances of patients being forgotten about, as they are moved from ward to ward.

And it is the most vulnerable that this impacts upon. The elderly, infirm patients who are most affected by being moved, are also the patients most likely to be moved from wards, to accommodate new admissions. Moving elderly patients can precipitate acute confusional states and general deterioration in their health.

Over-crowding and moving people around hospital wards can increase the risk of contracting and passing on infections, such as C.difficile. Last month, the Welsh Conservatives obtained figures showing that in 2007-08, more than 3000 people aged over 65 contracted the C.difficile infection.

NHS Trust finances could be a possible reason for the decline in bed numbers. There are extra financial pressures on managers at the moment, to balance their books, before the planned NHS reorganisation becomes fully operational in October. And one of the easiest ways of making efficiency savings is to cut bed numbers, regardless of the dire consequences this can have for patient care.

So, the BMA is calling for a change in bed occupancy policy, with less emphasis on dwindling bed numbers, at a time when we have a growing ageing population, who need more long-term treatment in hospitals. Patients, in particular elderly ones, are being put in danger and this must not be allowed to continue.

We also feel it would be beneficial to change the way statistics are collated and reported so that they better reflect what is going on in Acute hospital beds.

It would be good to hear from any members or the wider medical profession, if they've encountered any of the above issues...

Statistics available at


  1. I couldn't agree more with every word said in this post. Average number of wards elderly frail patients in my Hospital with multiple pathology visit in one admission episode is 3 and they are under at least 3 consultants at varying times of their stay in Hospital during that admission episode.
    Over the years we, the clinicians haven't voiced enough concern about this and mannagement have bulldozed every "re-organisation" in name of cost efficiency which thay themselves can't explain. It is high time we as clinicians looking after these patients (who end up being confused/ disorientated), say enough is enough and REFUSE to comply and tell the BED managers that ALL frail elderly patients should be first priority in terms of being on right ward from the day of admission as mortality is higher than Acute MI / Cancer / Respiratory failure put together.
    We need to name and shame the management to help our patients.

  2. Thanks for your supportive comments. I am pleased that we managed to raise the profile of this important issue. I hope that Doctors across Wales will highlight bed occupancy with their executives and boards, and put patient safety first.
    Dr Stefan Coghlan
    Chairman Welsh Consultants Committee


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