Feature

Beds going down, work going up

The Radical Statistics Health Group charts the rises and falls of the NHS under a Labour administration

any changes have taken place in NHS statistics since May 1997. The combination of the Internet and more open government have resulted in data being released to the public by the Department of Health in greater detail than before, making it possible to compare trusts and geographical areas – but making trends more difficult to see clearly. Trust mergers, changes in HA areas to support Primary Care Groups and changes in the way figures are defined and compiled are making it difficult to monitor trends over time. This article looks at data about hospitals in England, but similar issues arise across the UK and in other areas of health care.

Inpatient capacity is measured in terms of the average numbers of beds available daily, shown in Figure 1. This has been decreasing for many years. The decline in bed availability for people with mental illness and learning disabilities is a result of the closure of long stay institutions, and the availability of beds for older people has fallen as long term care has been transferred to the private sector, while NHS hospitals have increasingly offered only acute care to older people. The fall in maternity bed availability reflects the closure of smaller units and ever shortening postnatal stays.

In the acute sector falling bed availability – due to shorter postoperative stays and wider use of day case surgery – continued until 1994/95 and remained stable until 1997/98, the most recent year for which data are available.¹ The scope for further reductions is unknown, as is the impact of the bed losses which will occur when the new PFI hospitals open.

Meanwhile, the statistics in Figure 2 show continuing increases in hospital activity.¹ These data come from the Department of Health’s KP70 returns, based on aggregated data, in which inpatient stays are still counted in terms of finished consultant episodes. But the DH now links data about successive episodes within the same hospital stay to produce counts of numbers of ‘hospital spells’ — similar to the ‘discharges and deaths’ which were counted up to the mid-1980s. Although there are good reasons for this, confusion can arise if figures about episodes and spells are combined.

Labour’s high profile pledge to reduce the number of people waiting for inpatient and day case treatment has led to increased statistical activity and frequency of publication. For the past year national figures have appeared in monthly press releases and local data have been published on the DH web site quarterly (www.doh.gov.uk/waitingtimes/), while previously they were published only twice a year. Despite the increase in detail, with figures analysed both by HA and by trust, national trends are harder to come by and must either be pieced together from press releases or requested from DH statistical staff.

Figure 3 continues the old series of six monthly trust-based data. It shows that waiting list numbers were rising steadily in the pre-election period, when Labour made its promise, and continued to rise until March 1998, since when they have fallen. But as the monthly resident-based data in Figure 4 show, the fall has not been a steady one. After falling in November 1998, numbers rose again in December and after further significant decreases between January and March 1999, the pace has slackened.

Of course, the debate continues about whether the number of people waiting is more relevant than the time they have to wait. As healthmatters went to press, health secretary Alan Milburn was being challenged on precisely this issue.