Annex A > Chapter 6 - Funding and Resources > Resources > Beds
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Beds
140 As regards shortages of beds, a visit to the Bristol hospitals in October 1986 by the General Professional Training Team of the Royal College of Physicians reported that:
`The number of beds in the Bristol Royal Infirmary in Medicine is just about adequate to enable training of the present Junior Staff level, and further reductions in bed numbers might impair the training programme. Junior Staff were genuinely concerned that they spend too much time attempting to find beds.' [194]
141 As regards delays in admitting paediatric patients, the minutes of meetings of the Division of Children's Services [195] commented on shortages of beds in the Children's Hospital throughout 1987:
`April. Restriction of admissions ... Dr Hinde reported that the bed situation in the Children's Hospital had eased somewhat over the past month, although this was a normal trend for the time of year. Notwithstanding this, the ITU had been closed to admissions between 17th-20th March, and the whole Hospital had been closed on 24th March. In addition, a total of 7 transfers to Southmead had had to take place during April (to date) because of lack of available cubicles for children needing isolation. It was noted with concern that the BCH was still not functioning fully as a District General Hospital for Children.
`It was further noted that the only long-term solution to the problem was to open one of the closed wards, but that this would require funding for additional nursing staff. Miss Stoneham advised Division that the deficiencies in the service being provided by the Hospital were regularly pointed out to the District Health Authority.' [196]
`May. Restriction on admissions ... Dr Hinde reported that, during the past month, it had not been necessary to refuse any admissions. This was considered, however, to be the normal seasonal pattern, and Division still endorsed the need for action to be taken to avoid a repetition of the severe bed problems that had been experienced during the Winter months.' [197]
`July. Closure of hospital to admissions. Dr Hinde wished to draw the Division's attention to the situation which had once again arisen recently, when there had been no paediatric beds available in Bristol for emergency admissions. On that occasion it had been necessary to discharge sick children from BCH against informed medial opinion.
`The Chairman acknowledged receipt of Dr Hinde's letter on this issue, and undertook to respond when he had had an opportunity to consider it more fully, and to bring the concern of Division about patient safety once again to the attention of the Health Authority.'
The minute noted that savings of £26, 000 had to be identified out of the medical staffing budget over the next ten years. [198]
142 In January 1991, the minutes of the meeting of the Division of Surgery recorded:
`Because of the lack of funds, the ITU would remain at its present size of 7 beds when the ceiling replacement and refurbishment were undertaken.' [199]
143 In relation to paediatric cardiac surgery at the BRI, Mrs Fiona Thomas [200] stated in her written evidence to the Inquiry:
`Some surgeons complained at times if there was a shortage of beds for adult cases as children were staying in ITU and blocking beds.' [201]
She stated that, at this time, the adult service was being expanded, but that beds in the ITU were often occupied by children. This only enabled a certain number of adult patients to be operated upon on any given day. [202]
144 Fiona Thomas explained, in the following exchange:
`Q. So it could be the case, could it not, that there would be adults ready, willing and able to have their operations, but no available space in intensive care to house them after the operation?
`A Yes. It is the same situation as there is today, yes: lack of beds, basically, in the intensive care unit. Patients are not well enough to move through as we would have necessarily planned, yes.
`Q. So there is always a demand for particularly adults to have surgery, and one of the bottlenecks is to be found in intensive care?
`Q. But that bottleneck would be more marked, more profound in the days when there were children in the intensive care because they would be there for longer?
`A. Yes, and you could have three or four beds blocked for a longer period of time because they were not moving through, yes.
`Q. So that led to some tension, did it?
`A. Yes, it did, yes.' [203]
145 Kay Armstrong [204] told the Inquiry that it was a regular occurrence to be told at the start of a day that an operation would have to be cancelled because of the lack of an intensive care bed, or a shortage of trained nurses in the ICU or the operating theatres. [205]
146 Dr Piers Rowlandson, a referring consultant paediatrician from Swindon, stated in his written evidence to the Inquiry that delays due to shortages of beds were not peculiar to Bristol. He explained that children with heart problems were referred from Swindon to either Bristol or Oxford. He stated that, initially, Oxford had not appointed a dedicated paediatric cardiac surgeon, but that even:
`... when Oxford had appointed a paediatric cardiac surgeon the choice was still Bristol for many patients because of lack of beds in Oxford. Bristol too often had a problem finding a bed. The whole service seemed chronically under resourced.' [206]
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Footnotes
[194] WIT 0032 0255 Professor Sir George Alberti
[195] Of the Bristol and Weston District Health Authority
[196] UBHT 0211 0085; minutes of meeting held on 21 April 1987 (month emphasised in original)
[197] UBHT 0211 0078; minutes of meeting held on 19 May 1987 (month emphasised in original)
[198] UBHT 0211 0049; minutes of meeting held on 21 July 1987 (month emphasised in original)
[199] UBHT 0200 0046; minutes of meeting held on 9 January 1991
[200] Clinical Nurse Manager, BRI
[201] WIT 0114 0029 Fiona Thomas
[202] WIT 0114 0029 Fiona Thomas
[204] Cardiac Sister, BRI, 1984-1995
[205] T59 p.12-13 Mrs Armstrong
[206] REF 0001 0036; letter from Dr Rowlandson dated 31 August 1999