Tuesday 30 July 2013

Supply and demand

Over the years I’ve sat in a number of meetings with health service managers and professionals who have patiently explained why there is no need for anyone to worry about reductions in the number of beds in our hospitals.  Their logic has always struck me as impeccable.  Treating more people in the community, shorter hospital stays, less invasive surgery – all of these should indeed lead to a reduction in the total number of beds required.
Logic, however, isn’t enough if there are underlying problems with the data and assumptions.  And if the starting point is not right in the first place, then simply moving the goalposts in line with changes in all the factors listed simply perpetuates any mismatch between total demand and total supply.  Sooner or later such contradictions will inevitably be exposed.
This report a week or two ago that 2600 routine operations were cancelled because of a “lack of beds” should come as no surprise to anyone, in that context.  What was a surprise however – even to a hardened old cynic like me – was the way in which health chiefs explained the situation.  Even more surprising is that they appear to have got away with it.
The problem, to listen to them, is not on the supply side at all – it’s on the demand side.  There aren’t really too few beds – just too many patients.  It’s not their planning and assumptions that are wrong – it’s simply that too many of us became ill last winter.  In short, it’s our fault not theirs.
The problem with dismissing the problems of last winter as some some sort of blip as a result of too many people becoming ill is that no proper action is taken to address the underlying mismatch between supply and demand.  And unless that is done, we can probably expect a repeat at some point in the future.
How on earth are those in authority getting away with this one?


G Horton-Jones said...

This could be the aftermath of the bed blocking farce of a few years ago when admissions were dealt with with no thought to post op care ie no beds equals no bed blocking

A similar thing is happening in the military where ex military personnel are dumped back into the civilian world in a pure numbers game.

People are simply numbers I remember the Falklands where some spokesman said that the Brecon Beacons were like the Falklands as was Belize, Northern Ireland, Afghanistan,etc

Not surprisingly three people have recently lost their lives needlessly in the Beacons

A Welsh Army will take care of its own

Anonymous said...

As someone who had an operation in hospital involving two surgical specialties recently, I have good understanding of why this 'bed blocking issue' causes cancellation and postponement of operations.

I needed a hernia repair, a routine straightforward operation not requiring overnight accommodation and also excision of cysts, again a relatively straightforward procedure not requiring overnight accommodation. The former is done by a general surgeon and latter by a urology surgeon. It involves one incision and two specialties to wield the scalpel inside my groin area. As expected, in the event I didn't need overnight accommodation, but the procedure was delayed nine times, because of 'no beds'. The reason for this is because the general surgeon specialising in hernia repair would have conducted a number of hernia operations on that date, and it only takes one of these 'booked' patients to require a bed for the whole theatre booking of operations by this surgeon to be delayed. The same applied to the urology consultant.

My operation needed all of the following conditions to be met, (a) only one incision in myself, less risk, (b) if any of the other hernia operations booked that day needed a bed, for example a more elderly man, all would have to be postponed to accommodate that patient before surgery, and (c) if any of the cyst operations booked that day needed a bed, for example cancer found requiring more cutting that would have also have required a bed available. Essentially I was in a 'chain', and if any link or other patient in that chain required a bed which was not available the whole caboodle would need to be cancelled or delayed, effecting all patients being operated on that day, by two different specialties. I therefore suggested the rather simplistic 'supply and demand' concept rather silly.

Likewise in my line of work, nothing happens until a heavy lifting crane is on site, and out of ten sites that crane has been booked so far this year the crane has never been used. It's only there if things go wrong. No job of this type is conducted without the crane available. The crane hire firm knows this, as the risk in it's absence is closing the GWML for a week. It is nonsense to measure the 'cost of a crane' as a measure of efficiency, and no-one in the industry talks about reducing costs by doing jobs without heavy lifting cranes being available. It is for this reason I now understand that when NHS managers talk about 'cost of a hospital bed', and cutting costs by removing beds from hospitals. It is the voice of stupidity. If you ever get to meet one of these 'health service managers' again, Mr Dixon, you may wish to remind them of a railway engineer who got his hernia fixed after nine cancellations, who hires the most expensive crane in Wales which has never been used. I suspect there are also surgeons in Welsh hospitals who have one eye on the scalpel and one eye on the absence of a bed down the corridor.

Ironically, in my case, the consultant reminded me that to avoid any repeat hernias it's best to use a crane.