Thank you. I worked in various hospitals, chronic and acute conditions, in the 1950s, and then taught on the topic among others from the mid-1960s. My memory is not that this was a matter of deliberate planning to keep beds and staff unoccupied but that what was seen as a problem of unused but necessary resources changed from tolerating, perhaps rationalising, a lower average occupancy rate, to expecting a higher one. The reference to politicians was of course to political rhetoric which may have been the post-truth of those days, that not worrying about what had been a lower average bed occupancy rate over a period of time changed under the pressure of political rhetoric about wastefulness and better business management with parallels from the hospitality business 'which knows how to run such things'. Obviously a lot depends on how far the bed and staff capacity has been planned based on reliable data about predictable flows etc -- does that strategic planning capacity exist nowadays as it did? Did it work? Perhaps the search for explanations of national differences lies not only in definitions of the institutional setting of what is hospital bed provision but in planning versus competition? High occupancy rates can mean goal achievement in some situations [hotel management] which are failures in others [hospital crises]. Risk data may justify extra capacity not in constant use [think fire extinguishers, insurance]. What do we know about the fluctuations on the demand side other than during crises like you mention? 

John VW.

------------------------------------------------------------
From Professor John Veit-Wilson
Newcastle University GPS -- Sociology
Newcastle upon Tyne NE1 7RU, England.
Tel: 0044[0]191-208 7498
email [log in to unmask]
www.staff.ncl.ac.uk/j.veit-wilson/
-----Original Message-----
From: email list for Radical Statistics [mailto:[log in to unmask]] On Behalf Of John Whittington
Sent: 16 November 2016 13:02
To: [log in to unmask]
Subject: Re: Hospital beds

At 12:26 16/11/2016 +0000, John Veit-Wilson wrote:
>I understood occupancy rates used to be considered acceptable at lower 
>levels because the need for a vacant beds margin for merely fortuitous 
>fluctuation in medical demand quite apart from crisis was well 
>understood in hospital administration before the introduction of 
>managerialism . The pressure for 95 or 100% occupancy comes from the 
>political introduction into the NHS of an inappropriate business model 
>drawn from hotel occupancy which doesn t need to accommodate 
>fluctuations or crises, and the pressures of cuts.[/quote]

At least in my experience, the issue has nothing to do with policies or 'targets' regarding bed occupancy but, rather, to the realities of supply/demand.

I don't know when you think this 'inappropriate business model' arose, but when I did my first hospital job back in 1973, a very substantial proportion of my time (which, incidentally, was contracted as 120
hours/week!!) was spent literally fighting to find beds for patients requiring emergency admission.  I was 'running' a 30-bed orthopaedic ward and we very rarely had any empty beds at all.  We had a constant (and
uncontrollable) inflow of emergency admissions due to trauma, mainly from the local major roads, and I usually had to 'beg, borrow or steal' beds on other wards to accommodate them - even to the extent of putting adults with broken bones, head injuries etc. into children's wards or even psychiatric wards.

We had long waiting lists of patients waiting for elective surgery (mainly joint replacements etc.) but were lucky if we could admit more than two or three of those per week (even though we could have done far more operations than that).  Even then we often had to 'cheat' by keeping some other patient in hospital slightly longer than was necessary, until the moment the elective patient was available to 'jump into their bed', without the risk of an emergency admission getting into the bed first - or, equally unsatisfactorily, sending a patient home prematurely in order to create a bed for an elective admission!

Although I'm talking about one speciality, and one hospital, my subsequent experiences have been the same, as has been what I've heard from colleagues in other specialities and other hospitals.  I therefore think that one probably has to go back much further than that 43 years to a time when there were actually any 'margins' (deliberate contingency reserves of empty
beds) in most NHS hospitals.

Kind Regards,


John

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