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 http://www.statswales.wales.gov.uk/tableviewer/document.aspx?FileId=1996

Patient safety has to be at the forefront of the Welsh NHS

This Western Mail article regarding NHS safety breaches is a cause for concern for anyone working in the NHS, as well as to patients.

Patient safety is paramount at all times in the Welsh NHS, but it would perhaps be naïve to think ALL risks can be removed. For instance, when the health service is running at full capacity, with staff under pressure to get patients in and out of hospital quickly, it is inevitable patient care will suffer at some point. It is also at times like this, with such a high turn over of patients, that cleanliness standards are likely to fall, which can lead to the spread of hospital acquired infections such as C. difficile. Just last week the Welsh Conservatives published figures showing the rate at which such infections are spreading in Wales.

Here are a few of the recommendations the BMA has made in the past in trying to prevent such incidents of hospital super bugs;
• Healthcare professionals must follow hygiene standards relating to hand washing. Effective hand hygiene is the single most important intervention in infection control.
• Hand hygiene needs better ward/clinic design and provision; hot water and liquid soaps play an important role.
• Health professionals are duty bound to ensure that they and their colleagues fulfil their responsibilities with regard to infection prevention and control. Senior staff should lead by example.
Health care settings must be kept clean and dust free. Clinical and non-clinical waste must be disposed of effectively and appropriately.

It’s easy for such basic hygiene measures to fall by the way side, when the pressure is on NHS staff for a quick turn around in treating and discharging patients.
It is also worth highlighting a recent report from the Welsh Liberal Democrats,which showed how unsafe actual NHS buildings are, for both staff and patients, because basic, yet essential maintenance work, isn’t being carried out.

It isn’t really until you start delving a bit deeper and really looking behind these figures that you can identify such issues and then start putting them right. And these statistics show just how important an initiative one like the Save 1,000 Lives Campaign really is, which was set up with the primary aim to reduce risks to patient safety.