"I listened carefully to what the Minister said, but the Royal College of Physicians has warned that this winter there were more black alerts—when a hospital has no beds available—than there were over the previous 10 years combined."
Luciana Berger MP, House of Commons, 11 June 2013
"On the brink of collapse"?
Last year we looked at whether there was a shortage of hospital beds in the NHS after the Royal College of Physicians (RCP) warned that hospitals were struggling to cope with rising admissions and an ageing population. At the time, the RCP President went as far as to describe the NHS hospital system as "on the brink of collapse".
Dr Dan Poulter responded by issuing a statement in which he said this was a fallacy: "the NHS only uses approximately 85 per cent of the beds it has available, and more and more patients are being treated out of hospital".
The issue was back with a vengeance this week after Luciana Berger MP asked to be updated on the level of bed occupancy in hospitals. The Parliamentary Under Secretary of State for Health responded that there was nothing new under the sun. Again:
"occupancy rates for all NHS beds open overnight have remained stable between 84% and 87% since 2000".
According to Ms Berger, however, something has stood out lately:
"This winter there were more black alerts—when a hospital has no beds available—than there were over the previous 10 years combined."
Black alert is a hospital's most severe status level, on the apex of a 'traffic light' system of green, amber and red. It's issued when:
"all actions have failed to contain service pressure and the local health economy is unable to deliver comprehensive emergency care."
This means the hospital is at full capacity: admissions are temporarily closed, escalation beds are in use, patients are waiting in A&E for beds, and routine surgery is being cancelled.
It may happen, among other reasons, as a result of severe weather or an epidemic. In a report released in September, the RCP pointed to the shortage of out-of-hours doctors (as a result of the European Working Time Directive) and growing numbers of the elderly as potential long term causes behind the increased frequency in black alerts.
What the Royal College of Physicians say
We contacted the RCP to inquire about the data backing up the claim. We were surprised to learn it was not based on any published report or statistic, but rather on anecdotal evidence. The RCP explained:
"The Royal College of Physicians' members and fellows have been telling us for some time that the winter of 2012/13 has been the most difficult that many can remember, with some reporting that their trust has had more black alerts — where the hospital is closed to new admissions — this past winter than the previous 10 combined."
Dr Patrick Cadigan, a registrar at the RCP, also told us that:
"The RCP described the crisis facing acute care in our report, Hospitals on the edge? The time for action. It reported that there are a third fewer general and acute beds now than there were 25 years ago, but the last decade alone has seen a 37% increase in emergency admissions. The information from our members and fellows supports the data reported in Hospitals on the edge? The RCP is addressing the crisis in acute care via our groundbreaking Future Hospital Commission, which will report in September 2013'"
A parliamentary question from 2010 confirmed there isn't any centrally-collected on the frequency of black alerts in NHS hospitals in the past decade, so there's no obvious alternative to the members' and fellows' perceptions on the matter.
While the RCP have provided the source of the claim, we're left with no good reason to believe it's correct. If anything, closer reading of the RCP's response suggests that the view isn't even universally held amongst its members, so we've some reason to think the overall picture could be different.
Flickr image courtesy of StudioTempura
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