In an account of an Accident and Emergency (A&E) department, Sweeney (2000, p. 27)) argues that: ‘The curse in the NHS is to be ill, but not life-threateningly ill,’ or as the title of the article puts it: ‘You’re either dying or waiting.’ The winter of 1999/ 2000 generated the traditional, yearly debate on hospitals under stress, with patients waiting in corridors for admission to wards and where bed occupancy had reached saturation point. Government ministers tended to emphasise the flu outbreak as an exceptional occurrence: close to, if not an actual epidemic. Health workers were more likely to point to underlying problems. The Observer (9/01/00) newspaper reported that London had lost 40% of its acute beds since 1982, while the number of A&E departments had shrunk from 47 in 1981 to 31 now. The result, they argued, was that occupancy rates for beds had increased from 75% a decade ago to a level of 95%. With no slack in the system, even a small surge in demand results in crisis (McVeigh & Brown 2000, p. 5). Bed numbers have been decreasing from a peak of 480,000 in 1948 (DOH 2000a, p. 8) to the present level of 187,000 (see Table 1). While beds have decreased, activity across specialities has increased: care is more intense, but hospital stays have become shorter. In the mid 19th century, the average length of stay in hospital was 36 days, in 1938 18 days, in 1979 9.4 days, in 1989 6.4 days (Armstrong 1998), while statistics for 2000 suggests 6.2 days (see Table 2). There is, as Armstrong (1998) points out, a reduction in numbers of hospitals and beds alongside increased rates of hospitalisation, which, as Table 2 illustrates, has an international dimension so that increased admission rates and falling bed numbers go hand in hand. Decreases in length of stay is, according to the DOH (2002a) a sign of improved efficiency, but in the same document, emergency re-admissions are shown to have increased, suggesting that clients are being discharged prematurely from hospital. For example, re-admissions rates for fractured hips are up by 4.8%, while overall the increase is 1.7%. In most comparable countries to the UK, bed numbers per 1000 of the population has been decreasing in line with changing philosophies of how to deliver care (Hensher et al. 1999), but even accounting for this, the UK is worryingly low in comparison to countries such as France, Germany, and the Netherlands, although on a par with Spain and Poland and slightly better than the United States and Sweden (Table 3). The hospital may still be considered a modern cathedral (Illich 1976, p. 87), but its status is being reconstituted as economic pressures begin to question its efficiency, and discursively as biomedicine researches its efficacy. These problems are expressed most forcefully in bed crises. The hospital has evolved in ways that exacerbate these crises. Hospitals are increasingly focused on science and technology that concentrates on more specialised approaches. Collins (1997) argues that the centralisation of acute care into large hospitals will improve care as surgical expertise can be organised more efficiently and effectively. District General hospitals will close and new mega-hospitals would emerge to meet the specialisation of knowledge that contemporary medicine increasingly demands. Others are less clear that this will produce improvements in care, arguing that with the growth in technology, telemedicine and the virtual hospital, such centralisation will become anachronistic as clients are diagnosed and treated locally in smaller units, thus Accident and Emergency Nursing (2003) 11, 68–74 0965-2302/03/$ see front matter a 2003 Elsevier Science Ltd. All rights reserved. doi:10.1016/S0965-2302(02)00171-6
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Jan 1, 2019
Muhammad Fahad Ullah + 5
Open Access
