Feature

Fewer beds, but more patients?

What’s the statistical verdict on the NHS changes? The Radical Statistics Health Group offer some early evidence

As national statistics take some time to compile, data for the financial year 1991-92, the first year of the NHS internal market, have emerged only recently. This page presents a selection of data for England.

Figure 1 shows the continuing decline in the availability of hospital beds.^{1 2} The process of closure of long stay hospitals for people with mental illness or severe learning difficulties is a long term one which accelerated in the late 1980s. Unfortunately the statistics do not follow the residents out into the community to provide information about their rehousing and the care they now receive. The same applies to the more recent decline in beds in geriatric wards, nor is any distinction made between long stay and acute geriatric beds. The decline in numbers of acute beds has also accelerated since the late 1980s.

This decline reflects the increasing numbers of day case admissions, shown in figure 2, in addition to cuts and closure. Figure 2 also shows sharp reported increases in all types of hospital activity in the acute sector in 1991-92, compared with the stagnant picture for 1990-91.² This increase has been cited by the government as evidence of the success of the internal market. Closer inspection in some districts suggests strongly that the increase may result from more meticulous counting since the introduction of the internal market.^{3 4} This applies particularly to ‘finished consultant episodes’, which are derived by counting people each time they change consultant within a hospital stay. As the graph shows, this change, with that of adding in ‘well babies’ born in hospital, has increased reported inpatient activity.

As expected, the introduction of the internal market added further to the growing numbers of managers and administrative and clerical staff. This is shown in figure 3.⁵ Press reporting has contrasted this with a falling number of nurses and midwives. One reason is the transfer of senior nurses and midwives to management grades, but the statistics do not allow the numbers transferred to be counted. A second reason is the introduction of Project 2000. Student nurses and midwives on the new courses are no longer counted in the staffing figures.

These two changes make it difficult to assess the contribution of job cuts and redundancies to the decline in nurse and midwife numbers. But figure 4 does make clear that there is considerable regional variation in the decline.⁶