11. THE NUMBER OF BEDS WE PROPOSE TO PROVIDE

The question of how many in-patient beds there should be is often a matter of hot debate. The number of beds in acute hospitals has been falling for decades. There are many reasons for this:

These factors have reduced both the demand for beds and the lengths of stay. The consequential reduction in bed numbers has usually been prompted by the quest for greater efficiency, driven by government Treasuries and insurance companies throughout the Western world. As a result, bed numbers have been ‘tight’ for decades – the problem of finding enough beds for emergency admissions felt as testing in the 1970s as it has felt in the 1990s.

Trying to predict the right number of in-patient beds for the future is difficult. Will the present general trends in surgery (more and more being done less invasively) continue? The answer is certainly yes, but whether they accelerate and how fast is unpredictable. General medicine is different – the number of medical emergency admissions continues to increase, but it is likely that more of them will be able to be managed with less time in hospital. What is difficult to predict is how these two trends will combine. Similarly although there are predictions that the population of Greater Glasgow will continue to decline, this cannot be seen as inevitable. The Glasgow Alliance (a group of partners including the City Council, Scottish Homes, Glasgow Development Agency, Greater Glasgow NHS Board and others) have developed a policy to create "New Neighbourhoods" in Ruchill\Keppoch and Drumchapel as part of a strategy to reduce the decline in population. In addition the new UK government policy to redistribute asylum seekers is likely to see 6,000 – 7,000 asylum seekers being accommodated each year in Glasgow for several years. It is assumed that asylum seekers will be resident for 2 to 3 years before the outcome of their application is known.

Of course, older people tend to need hospital admission more than young people. Even if the total size of population declines, it is likely that the proportion of older people in the population will increase.

What does all this add up to? Most statisticians estimate that Glasgow’s population will continue to decline, but they would accept that the number of elderly people will become more significant. We suspect that the Glasgow Alliance’s attempts to stem the decline in population will have at least some success and we know for a fact that the statisticians have not yet taken account of the thousands of asylum seekers who will need to use health services in Glasgow.

Our conclusion therefore is that there may not be any overall reduction in the expressed demand for beds as a result of population changes. We think the long-standing trend for decline in Glasgow’s population will be counter-balanced by other factors ("New Neighbourhoods", asylum seekers, more elderly people).

This leaves the question of changing practice in health care. The trends we have described (more day case surgery; new medicines; more active rehabilitation; better discharge planning; better home care; more efficient arrangements for tests and preparation for treatment) will continue. But how fast?

Our leaflets:

tell you more.

We have decided to be cautious. If we were deciding to build two or three complete new hospitals in the next five years we would need to commit ourselves now to a fairly precise number of beds for a period of 30 years or so. (Our leaflet on "How the Finance Works" explains why decisions on capital investment in new buildings can commit the NHS to costs in bricks and mortar for long periods of time). But we are not proposing to do that. Our proposals allow us to pause and reflect on future bed number requirements half way through our programme of modernisation and change. Nor would we find ourselves in the position of there not being enough capacity in Glasgow hospitals if by any chance present trends in bed use slowed down dramatically.

Half way through our programme we would be able to decide:

Yet by that half way point our use of new facilities would add up to:

Despite our caution about population numbers and trends in medicine and surgery we do need to take a view about the relative efficiency with which beds will be used. What average length of stay do we expect to achieve? How intensively will we use the beds we have? We have taken into account the effect that deprivation and poor health status of the Glasgow population might have on their need to use hospital beds and the length of time they need to spend in hospital. We have assumed that demand for use of beds will continue to grow, but have also taken into account that Lanarkshire Health Board wishes to see more Lanarkshire residents treated in Lanarkshire Hospitals rather than in Glasgow.

In broad terms our projection for bed requirements in 2005 falls into two different forecasts:

 

Current No. of Beds

in Glasgow

Forecast A

Forecast B

 

North

South

Total

North

South

Total

Difference

North

South

Total

Difference

Surgery *

601

311

912

367

217

584

- 328

414

237

651

- 261

Medicine **

803

383

1186

828

466

1294

+ 108

808

383

1191

+ 5

Orthopaedics\
Plastics

292

146

438

179

101

280

- 158

202

115

317

- 121

Beatson Oncology

141

-

141

130

-

130

- 11

130

-

130

- 11

Cardiothoracic

94

-

94

94

-

94

-

94

-

94

-

Neuroservices

-

183

183

-

183

183

-

-

183

183

-

 

1931

1023

2954

1598

967

2565

- 389

1648

918

2566

- 388

* "Surgery" includes General Surgery, Eyes, ENT, Urology, Gynaecology and Intensive Care.

** "Medicine" includes General Medicine, Cardiology, Communicable Disease, Rheumatology, Dermatology, Respiratory Medicine, Homeopathy, Nephrology, Haematology.

These figures also exclude maternity, paediatrics (children), day case beds, mental illness and beds for physically disabled people.

Forecast A assumes 5% growth in demand in general medicine, 0% in other services.

Forecast B assumes 2% growth in demand in all specialties.

These figures exclude those beds currently designated for elderly people (the specialty is known as "Geriatrics"). There are currently 1623 of these beds - for assessment (501), rehabilitation (330) and continuing care (792). Their future number will be influenced by the continuing debate about what the most effective patterns of care are for elderly people and how NHS services and local authority community care responsibilities best relate to each other.

In summary we expect to see a reduction in surgical beds but either no reduction in medical beds or else a modest increase for which we would need to find the running costs.

Details for individual specialties within these numbers will need to be refined in developing Outline Business Cases when building any new ward accommodation (e.g. at Southern General, the Victoria Infirmary rehabilitation beds, Gartnavel) or in transferring ward capacity from one hospital to another. Beyond that, in mid-decade, we would take stock again of future bed requirements before committing to the second part of the modernisation programme (more new beds in South, West and North-East Glasgow to replace beds in old buildings still in use).

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