REPORT BY THE COMPTROLLER AND AUDITOR GENERAL:
INPATIENT ADMISSIONS AND BED MANAGEMENT IN NHS ACUTE HOSPITALS
(HC 254)
INPATIENT ADMISSIONS AND BED MANAGEMENT
IN NHS ACUTE HOSPITALS (PAC 1999-2000/132)
Press notice by the NHS Confederation
INTRODUCTION
Two recent reports, the National Beds Inquiry
and National Audit Office's Inpatient Admissions and Bed Management
in NHS acute hospitals, on the management of inpatient admissions
acknowledge the growing demand on the NHS in terms both of emergency
admissions and the need to reduce waiting lists for elective surgery.
Both reports reveal some variation in the quality of bed management
across the acute trusts in England.
INVESTING IN
ALTERNATIVE PROVISION
However, these two important pieces of research
appear to point in different directions. The National Beds
Enquiry postulates a correlation between successful bed management
and the quality and availability of alternatives to acute care,
namely those acute trusts with access to well-resourced alternatives
are less likely to have problems with bed management.
By contrast the NAO report2 looks at acute sector
in isolation and advocates more intensive micro-management of
the acute bed system. Given the findings of the National Beds
Enquiry there is some doubt that the investment of resources as
advocated by the NAO will produce significant benefits, most of
which is at the margin of a system already functioning close to
capacity.
OCCUPANCY LEVELS
For the last 20 years the Health Service has
been required to produce an efficiency savings for 3 per cent
each year. The cumulative effect of efficiency savings has been
an increase in bed occupancy from 70 per cent or so in the 1970s
to over 90 per cent today, leaving little capacity to cope with
peaks in demand.
Many of the problems of delayed admission and
cancellation of elective surgery are the product of too high occupancy
rates. As the National Audit Office report2 says:
"Recent research indicates that, hospitals
with average occupancy levels above 85 per cent can expect to
have regular shortages and periodic crises" (p 7).
Other recent research has suggested that occupancy
levels may be lower than 85 per cent. However, it should be recognised
that he method by which the NHS assesses bed occupancy (ie at
midnight) consistently underestimates the occupancy level in acute
hospitals.
COMPUTERISED BED
MANAGEMENT
The National Audit Office report1 recommended
investment in information management systems for bed management.
For those hospitals with an existing hardwad infrastructure (principally
a terminal on each hospital ward) this represents a relatively
modest investment of about £40,000 per annum plus start-up
and recurrent training costs.
For hospitals without such an infrastructure
the introduction of a bed management system would present an additional
cost on top of a multi-million pound development.
The NHS already has a strategy for information
management and technology3 which is directed at improving the
quality of patient care through the introduction of lifelong health
records and a number of related initiatives. Bed management systems
do not feature in the strategy. While not antagonistic to this
project, bed management systems do not rate as a priority given
the extremely scarce resource available for investing in IM&T.
HNS bodies would need some clear guidance on the priority accorded
to such investments.
The National Beds inquiry highlights the need
to take a holistic view on the issue of bed management. The NHS
Confederations hopes the welcome new injection of funds to the
Health Service will enable such a strategy to be adopted.
NHS Confederation
29 March 2000
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