Epidemic or not, the NHS is suffering

13 Jan 00
Whether the outbreak of flu sweeping Britain is an epidemic is a moot point. Statistically, it isn't. The official figures for reported cases are little more than for January last year.

14 January 2000

Yet Dr Liam Donaldson, the chief medical officer, has openly used the word epidemic, which he justifies on estimates of the number of sufferers who have not bothered to consult a doctor. Some others suspect he may be concerned to justify the government's stewardship of increasingly hard-to-find intensive care beds.

What is certain is that the flu crisis has focused attention on whether, this year or next, the NHS is capable of coping with a widespread outbreak, epidemic or not. As usual, it is a question of money.

Managers and doctors are adamant that government policy is setting the NHS on course for another winter crisis next year. This week they called on ministers to abandon the efficiency savings that have reduced bed capacity, while a health service expert warned that the Private Finance Initiative was reducing hospitals' ability to cope with the seasonal demand still further.

Annual efficiency savings of around 3% have been imposed on the service, first by the Conservatives in the 1980s, and more recently by Labour.

Though it is generally accepted that economies were possible up to the early 1990s, staff report that the only way to achieve the desired savings now is by cutting essential services. Bed capacity has been cut to dangerously low levels and the service is now less well able to cope with increased demand, they say.

Bed occupancy rates in many hospitals run at between 90% and 95%, even though the royal colleges recommend 80% occupancy to cope with peaks of demand. Private hospitals have a rate around 50%, which enables them to ensure waiting lists are relatively small.

The government's own research has found that periodic bed crises are inevitable with levels of more than 90%. Yet the government has asked the service to find a further 3% in efficiency savings in 2000/01.

NHS Confederation chief executive Stephen Thornton labelled this counter-productive. 'If this requirement remains, there is a real danger that bed occupancy can only rise further next year,' he said.

He called on the government to review the target. 'We need a new approach to efficiency, based on strategic capital investment which will produce real efficiency improvements for the future. At the moment, "efficiency" in the NHS has come to mean a dilution of quality.'

Peter Hawker, the British Medical Association's consultants' leader, said the NHS should plan bed numbers for an ageing population.

'I was glad to hear the chief medical officer say that our planning must take particular account of the health needs of older people,' he said.

'I hope that is a strong signal that we will stop the relentless drive to cut out bed capacity in our hospitals.

'Older patients often have multiple health problems and their stays in hospital will inevitably be longer than for younger, fitter patients. It is time we recognised that our assumptions about bed numbers need to be built on real need.'

The PFI threatens to reduce bed capacity still further, according to Professor Allyson Pollock, head of the health policy and health services research unit at University College London.

She said the number of beds has remained static at around 108,000 since 1994/95 but bed numbers would fall by 30% in the first 15 PFI schemes.

Beds are only part of the problem. The UK has fewer doctors as a proportion of the population than many other European countries, and there are at least 7,000 nursing vacancies in England alone.

PFI is also a threat to staff numbers, Pollock said. 'We are seeing reductions in clinical staff budgets of 20% to 25%, mainly in nursing. The scenario is that there will be lovely new hospitals but many fewer patients are going to be admitted.'

The government has poured extra cash into the NHS to modernise intensive care facilities, increase the number of medical students and attract nurses into the service. But these will take years to make a difference on the ground.

Even the youngest consultant spends 15 years in training, and though more than 2,000 nurses have come back to the NHS in the past year the feeling is that these are merely replacing those who are leaving.

This year the NHS is coping, just. But much of this is down to winter planning by local hospitals, health authorities and social services. And this year, an extra 100 intensive care beds opened in England.

But unlike in the current year, the Department of Health's planning guidance for 2000/01 does not specifically mention the management of increased winter demand as a service priority.

NHS Direct, the nurse-led advice line, has undoubtedly helped prevent an even greater influx of patients into casualty departments and GP surgeries.

But waiting lists could be severely affected if the flu continues to spread. At the moment, its effects may only be short-term because hospitals had not scheduled non-urgent operations over Christmas and the New Year. They were due to begin again this week, but many have been postponed because beds were not available.

Hospitals now hope they will not be punished as a result. Stuart Marples, Institute of Healthcare Management director, said: 'Our hope is that the government recognises that such action is the only sensible strategy in these circumstances and does not penalise them for missing their waiting list or financial targets.'


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