IT is often said, and rightly so, that in spite of perennial concerns about waiting lists and nurse numbers, the NHS is second to none among state healthcare systems for its care of the seriously unwell.

Even these patients, however, are being affected by pressure on beds. An audit of critical care provision in high dependency units (HDUs), intensive care units (ICUs) and combined units in 2012 has revealed that one Scottish hospital, the Victoria Infirmary in Glasgow, discharged up to 8% of patients early from critical care into less acute wards.

Early discharge is defined as a transfer that is not in the best interests of a patient but necessary due to pressure on beds or staffing. Inverclyde Royal Hospital and Edinburgh Royal Infirmary also have high rates of early discharge.

Over at Forth Valley Health Board, meanwhile, what appears at first glance to be the opposite problem has emerged, with 45% of patients in the combined HDU/ICU at Forth Valley Royal Hospital having their discharge delayed.

In fact, this problem too is due to bed shortages, but in mainstream wards: patients are kept in critical care after the point at which they need to be there because there is simply not enough space on less acute wards.

Bed blocking on general wards, in other words, is causing bed blocking in critical care.

What all this means, as the Royal College of Nursing (Scotland) makes clear, is that many patients are having their recovery from serious illness and injury compromised.

For the past month, The Herald has been calling for a review of bed capacity as part of our NHS: Time for Action campaign. With an ageing population putting unprecedented pressures on the system, it is clear that such a review is needed to ensure there are the right beds with the right staff in the right place at the right time to cope with patient demand. Not having sufficient capacity in one part of a hospital has a ripple effect on other departments, as this report illustrates all too clearly: it could mean patients being held overnight on trolleys in A&E; it could mean patients being repeatedly moved between wards because the appropriate one is full; or it could mean that patients in critical care settings are discharged too early or too late.

A beds review is essential, but there also needs to be a proper investigation into community care provision. One cause of bed blocking is the holding of a patient in hospital while a care home place is found for them, or home care arranged. The process is often inefficient; what is more, sometimes such patients did not really need to be admitted to hospital in the first place but were brought in because of a lack of alternatives. Such issues must be addressed if the overall problem of bed shortages is to be dealt with. It is clear that early and delayed discharges from critical care are symptomatic of a much wider problem of hospital bed capacity that will probably become worse unless it is addressed now.