What bed is that, then? (part 1)
Entering the world of the bed manager...
Back in 2020 when politicians, NHS senior managers and journalists were scaring the public over the availability of hospital beds (lack, thereof) and of wards brimming to capacity and beyond I nudged members of John Dee’s Almanac into asking simple questions such as: what bed is that, then?
In the NHS there are beds, beds and beds. Not all beds are created equal and one of the more despised of NHS managers is the bed manager. You’ve got a nice, clean unit with beds made up ready to take surgery cases when along comes the bed manager and snaffles them. There are beds assigned to dedicated units such as thoracic surgery and cardiac surgery, and there are ward beds serving different specialisms and disciplines. Then there are beds serving the broad areas of mental illness, maternity, learning disabilities and geriatrics in addition to beds serving general and acute medicine1 (what the public think of as ‘beds’). Then there are paediatric beds, neonatal beds and adult beds. Then there are day beds and night beds.
It’s not just about beds…
Anybody who has worked in a hospital alongside senior managers will tell you that beds are only part of the picture. You can’t put a patient in a bed unless you have the nursing staff to care for them. Go below certain mandatory requirements - especially for critical care - and you have to close beds down; sometimes a whole ward. Neither can you steam ahead putting patients in beds without securing the means of getting them out again. Thus bed management is reliable on discharge procedures and this means engaging with registrars, senior house officers, pharmacy, relatives, carers, social workers, therapists, residential homes, care homes, porters and ambulance Trusts. Then there is the perpetual issue of the dwindling nursing pool, with bank and agency nurses filling holes in staff rosters (if you can coax them). On top of this there are staff absences - especially during a pandemic - with all these interlocking systems at the mercy of protocols and the PCR test.
Understanding the numbers
During the pandemic we were treated to daily bed use figures for COVID cases but we were never sure what they actually represented and just assumed these were very sick people needing a ventilator. The impression given was one of hospitals bursting at the seams, this being backed by social media streams from stressed healthcare professionals. Let’s have a look at some of that data and see what we can fathom with a dash of hindsight…
We shall start by plotting out Total Beds Occupied as reported by NHS England for the period 2nd April 2020 onward, this being a daily series published as part of the COVID-19 hospital activity monitoring programme (red line). The presumption here is that COVID cases will require overnight beds within general and acute medicine and thus Total Beds Occupied will be the grand total of such beds in use, enabling us to make a sensible calculation like percentage occupied by COVID cases. Before this presumption gels I shall turn to Bed Availability and Occupancy data for NHS England and overlay average daily occupied beds2 for both general and acute (G&A) night beds (blue line) and G&A night and day beds combined (green line)…
It’s pretty obvious that G&A beds alone fall way short of the mark even if we lump day beds with night beds. This means Total Beds Occupied is more than mere general and acute medicine and must include beds reserved for learning disabilities, maternity and mental illness. Here’s a second plot with these additional beds thrown into the mix…
There’s another of those pleasant surprises! It’s pretty obvious that what was being counted and called Total Beds Occupied for the COVID-19 monitoring programme were night and day beds across the major headings of general & acute, learning disabilities, maternity and mental illness.
FYI: Here’s a screenshot of the actual file used for the blue series…
Where does this leave us?
It leaves us in a situation whereby the general public, being logical, are going to assume that overnight beds for general and acute medicine were counted by NHS number crunchers, whereas they went and counted day beds as well as overnight beds - and both types of bed in maternity units, learning disability units and mental illness units. Not exactly a straight bat, what!
Suspicious types are going to assume that if they were counting every hospital bed they could they probably counted all the COVID cases in these beds to bump numbers for the minister. And they’d be right: herewith a screenshot fresh from the UK GOV coronavirus dashboard…
So there you go. Dare we say they left no bone unturned?
In epsiode #2 I shall peel the onion a little more by looking at bed availability before and during the pandemic.
Kettle On!
a.k.a critical care beds.
Calculated quarterly in arrears on a financial period basis, thus Q1 = Apr - Jun.