Cutting hospital beds is a false economic climate | Zara Aziz

‘It is accurate that our elderly population is living longer, but with a better burden of illness.’ Photograph: Alamy

A latest examine by the Organisation for Financial Co-operation and Development found the United kingdom had the 2nd lowest variety of hospital beds per capita in Europe. There are two.95 beds in the United kingdom per one,000 men and women, and we are seeing more and much more beds currently being lower as smaller sized hospitals amalgamate into larger trusts. The only country that has fewer beds is Sweden, but it has different patient demographics and invests more in community overall health providers, this kind of as for ailment prevention and management of prolonged-phrase problems.

It is symptomatic of the challenge facing the NHS. Commissioning groups and hospital trusts are asked to supply ever much more: reduce A&ampE attendance, unplanned admissions and outpatient waiting occasions, whilst concurrently coping with a workforce crisis and catastrophic budget cuts.

My patient Arthur is a sprightly 81-12 months-outdated retired lecturer, who lives in warden-controlled accommodation. He nursed his wife by means of breast cancer until she died two years ago. He typically manages well: he has meals on wheels and one carer check out a day, to aid with any home tasks or buying. If he needs to see a medical professional, he typically walks the 50 yards it will take to get to our surgery.

He has never ever requested a property pay a visit to right up until the Tuesday that he requests a home call. When I see him, he is quite brief of breath and agitated. I suspect that he has pneumonia. His oxygen ranges are slipping, so I arrange an emergency ambulance to take him to the local hospital. I ring the single level of referral telephone line (this accepts all acute GP health care and surgical admissions). It generally faces higher demand on most days, but that day the hospital is on “red alert”: ambulances are backing up in A&ampE, unable to transfer their individuals. There are no empty healthcare beds to talk of, and hospital doctors are urgently making an attempt to discharge inpatients.

Soon after eight hrs of waiting in A&ampE, Arthur is transferred to an outlying orthopaedic ward. His chest x-ray showed pneumonia. He is handled on intravenous antibiotics for 24 hours and discharged with oral antibiotics on Thursday. When I see him the subsequent day, he admits that he feels tiny better, but is adamant he needs no even more intervention in hospital, come what could. He is philosophical about the care he has acquired. “Absolutely everyone functions really challenging and with resigned excellent humour, but the method is bursting at the seams,” he says.

It is true that our elderly population is living longer, but with a greater burden of illness. The standard position of a generalist GP is altering, as we see far more expert work spilling out of secondary care. GPs are expected to absorb this operate, but with no further sources. When I 1st joined my practice in 2010, we utilised to have an in-residence local community matron (to support assistance our sufferers with prolonged-phrase conditions). The funding for this was cut, and we now share a matron with three other practices (covering a total baseline population of all around forty,000 patients).

Our neighborhood trust has undergone major reconfiguration, with the imminent closure of one massive hospital and the transfer of all companies to the other web site. This will consequence in a net loss of 200 acute beds, which is probably to impact sufferers like Arthur, and stretch primary care in Bristol in an unprecedented way.

Several NHS trusts in England face comparable reconfigurations, and the government would do nicely to emphasis on what this means at patient degree, as there are no “quick fixes” when planning healthcare demands for sick individuals. Cuts in numbers of hospital beds can only work if these are replaced with equivalent community-based solutions, this kind of as more stage-down intermediate beds. Otherwise we will carry on to see an escalation of failed hospital discharges and “revolving-door” admissions.

Cutting hospital beds is a false economic climate | Zara Aziz