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.
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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.