Hospital crisis: 'We need slack in system for busy NHS days'

IT may seem incredible that Scotland's busiest accident and emergency hospital ran out of beds this week and was on the verge of cancelling non-emergency surgery.

What could have caused such a crisis – a major incident or an epidemic? No, the tipping point was a series of serious road accidents on top of more problems with bed-blocking – relatively fit people who have nowhere else to go.

Readers may be surprised, but few at the Edinburgh Royal Infirmary would have been. This is the leaner, fitter NHS at work. It would be all too easy to criticise administrators for allowing such a situation to occur.

But numbers requiring admission after attending A&E cannot be forecast and they say the weekend's unusually high accident rate coincided with a "blip" in the number of beds that were being blocked by other patients. Nevertheless, some might say some slack should be built into the system to accommodate for such eventualities.

Critics will no doubt point to the revelation last week that in the past ten years 1000 beds have been shed at hospitals throughout the Lothians. They might well argue that this week's crisis is the result of such rationalisation and cost-cutting, which has seen the number of admission places reduced at all hospitals in the area. But the reality is that many of these beds are no longer needed on a permanent basis.

More people are being treated in the community than before, doing away with the need for them to attend or be admitted to hospital – although on today's evidence it seems that not too many GPs in the Lothians are willing to accept payments to open up their surgeries later in the evenings or on Saturdays to further expand community services.

But what has more bearing on the bigger picture is that in recent years advances have been made in both treatments and rehabilitation, meaning shorter stays in hospital for many patients.

Although this is countered to some degree by the fact that there is a greater requirement for beds for an increasingly elderly population, who are now living longer with previously certain killer diseases like cancer, the net result is that fewer beds are required.

Critics who would condemn the fact that there are too few beds would be just as incensed if wards were lying empty and staff were being paid to wait for something to happen.

There is little doubt hospital administrators have to perform a delicate balancing act to ensure that services operate within budgets and that the correct number of beds are available to meet future needs and potential emergencies. But then again they have hundreds of millions of pounds and tens of thousands of staff at their disposal to get it right.