We have 38% fewer hospital beds than in 1981: it’s a scandal
by Professor Peter Collignon, Crikey 20.7.09
Governments of all persuasions have tried to limit health expenditure by cutting hospital bed numbers, in the mistaken belief that less beds mean more efficiency. The result — not enough hospital beds available for the needs of many very sick patients.
Around Australia, this lack of beds in the wards of public hospitals results in frequent Emergency Department “bed block”, ambulance “bypass” and postponed elective surgery.
In Australia we have 38% less beds than in 1981 when there were 6.4 acute care hospital beds for every 1000 people. There are now only four beds per 1000 people available. Only 2.7 of these beds are available in the public sector — where the sickest patients are looked after.
In the ACT the situation is worse. There were only 2.3 public hospital beds available per 1000 residents in 2006-07 and we need to take into account that around 25% of these public hospital beds are filled by NSW residents. This effectively means there are only about 1.7 public hospital beds are available per 1000 ACT residents. By far the lowest ratio in Australia.
It is likely that the National Health and Hospitals Reform Commission report, whose release is expected shortly, will rightly put much emphasis on improving and strengthening primary care, but it is important that the need to improve hospitals’ capacity is not overlooked.
When there is a lack of beds, patients suffer. More complications and even deaths occur. Many are left in Emergency waiting rooms because too often there are no beds available to care for them. In those left at home, necessary surgery and medical therapy is delayed because there are no beds available to which they can be admitted. Some patients already admitted in smaller hospitals might require transfer to tertiary referral hospitals for more appropriate care but spend many days waiting for a bed to become available. This also means that their appropriate higher level care and therapy is delayed.
When you run a hospital at close to 100% occupancy, this makes hospitals less efficient — not more efficient. When full, there is no flexibility to move patients to the wards or areas that is most suitable for their care. They have to take a bed anywhere and then be moved (often multiple times) around the hospital until they arrive in the area of most appropriate care.
We need more acute care hospital beds. The number of beds we have available now too often fails to cope with the needs of those who are seriously ill and need to be in hospital.
We need adequate numbers of appropriately trained staff to look after the patients in additional beds. While we can’t produce large numbers of appropriately trained staff overnight, Governments should be able to look at what our needs are likely to be in the future and ensure we train and retain many more nurses, doctors and other healthcare workers. This can’t be done overnight but with appropriate planning and implementation it can start having an effect within a few years.
What number of beds should we have? No one can really be sure. But the number of available beds now is clearly not enough.
A 20% increase (to five beds per 1000 population) would seem to the minimum improvement necessary and the level we had in the 1980s (six beds) a preferable key performance indicator to strive for. When we no longer have “bed block”, ambulance “bypasses” and when those people triaged as “urgent” or higher can get rapid access to beds, then we know we have go the bed numbers correct.
It is time for all our political parties to give such a commitment. What is happening now in Canberra and around the country is intolerable and has to change. We need local and national targets for the number of adequately staffed acute care beds that should be available and then a concerted campaign over the next few years to make sure we get there.
Professor Peter Collignon is President, ACT Branch of the Australian Salaried Medical Officers Federation.
Euan J Thomas
Posted Monday, 20 July 2009 at 1:15 pm Permalink
That will explain why i’m waiting and waiting and waiting for a hip operation. Mean while getting stoned off my little brain on all the so-called pain killers the doctors keep prescriping for me. Oh well at least I’m getting legally stoned!
Posted Monday, 20 July 2009 at 1:34 pm Permalink
There have been significant changes in medical practice over the last twenty years. For example, if you had your appendix out in 1980, you probably stayed in hospital for 4-5 days. Now, you will be out in 2. A cataract operation which was done in 1980 required at least an overnight stay - now it is usually a day procedure. This means that if we were to do the same work that was done in 1980, we would need fewer beds.The issues of “bed block” may also be related to staff shortages (rather than lack of physical beds), or to lack of particular kinds of beds (intensive care, coronary care).
Posted Monday, 20 July 2009 at 1:36 pm Permalink
Euan J Thomas -Is your operation classified as “elective”?I can’t understand how they’re allowed to get away with this.My brother-in-law required surgery for cancer several yrs ago, and it was classified as “elective”. It’s horrific that people have to wait so long, when being in chronic/acute pain is recognized as ruining people’s general health, including their immune system.
Of course, if there are more available beds around the country, are there the necessary doctor/nursing staff to care for them anyway? Cutting back on the number of people allowed to study medicine started before the Howard govt I believe, and Howard just made the problem worse. I heard last week that patient toilets were closed in a large hospital in NSW due to cleaning staff being off sick. Pity the poor patients who had to trudge up or down a floor to visit the loo or have a shower etc?I asked a stupid question, ‘why not employ more cleaners’?Silly me! There are people out of work aren’t there?
Would the hospital system be any better if the Rudd govt took over?I often wonder how much money is wasted in having duplicate administrative positions around the country. It would be interesting to know these costs! I’d probably be shocked, and I think I’m pretty well aware of the current position. It’s a miracle that there aren’t more deaths - maybe they just keep them quiet!
I also heard that a new hospital in NSW that has just opened has 2 less beds than the old one it replaced?I just wonder what idiots are in charge of making these decisions?
Posted Monday, 20 July 2009 at 1:43 pm Permalink
The reduction in ‘beds’ over the years has also led to the widespread implementation of mixed gender wards - a situation which represents an erosion by stealth of the dignity of patients, both male and female. No one wants to hear about it though - I think we’ve passed the point of no return on this one.
Posted Monday, 20 July 2009 at 2:42 pm Permalink
Having been involved in many campaigns opposing the closure of hospitals and hospital beds over the last 30 years, I have to say that Peter is right and he has health system administrator support for his views. I remember sitting at a table as a union representative a couple of years ago when a senior NSW Health administrator admitted that too many beds had been closed. I made him repeat what he had said a couple of times, while I luxuriated in being vindicated. It is true that there is far more day stay, outpatient, and hospital in the home work now, and that there are bed closures due to staffing shortages and the lack of availability of the appropriate skill mix, particularly in nursing. These staffing shortages are being addressed, with the current Federal Government far more committed to registered nurse education than the Howard Government who were rapidly moving towards the de-skilling of nursing no matter what the cost to the quality of care. But more needs to be done. Much more. And Peter’s objective of 5 beds per 1000 of populations seems to be a reasonable objective. I am presuming he means public hospital beds otherwise the ugly difficulty of accessibility based on health insurance status arises.