DR Nick Scriven makes headline news with his proposal to deal with the bed blocking crisis in NHS Scotland by stopping elective operations for two months ("NHS ‘must axe routine ops for two months to beat crisis", The Herald, April 12). My previous letter on the subject (April 3) suggested a simpler solution: “Bed blocking is a major problem. Patients who are well enough to be sent home occupy hospital beds costing £235 per day. Hotel beds are available for £30 to £70 a day. Even with a care package, hotel costs would be £60 to £100. A considerable saving.
The true cost of bed blocking will be much greater since it affects the efficiency of the entire hospital. Other operations don’t get done. Operating staff are idle ...”
We make life much more complicated than it needs to be. There are simple solutions to most complex problems if we take the time to think through the situation.
In a simpler time, there were adequate care home beds in Scotland. There were places called convalescent homes. Bed blocking had yet to be invented by modern medicine.
We need to re-invent convalescent homes where recovering patients can be looked after at a fraction of the cost of a hospital bed. In the meantime, these patients could be accommodated in hotel beds with suitable support from social services.
John Black,
The Scottish Jacobite Party,
6 Woodhollow House, Helensburgh.
MUST the NHS “axe routine ops for two months to beat crisis”? Surely Dr Nick Scriven, president of the Society of Acute Medicine, would admit this would be a sticking plaster solution to the NHS’s current woes. Prof Derek Bell, president of the Royal College of Physicians of Edinburgh, pointed out that that which is routine can become urgent if neglected. Dr David Chung, vice-president of the Royal College of Emergency Medicine, asked for more staff, an “appropriate” number of beds (I think that means more), and greater social care provision.
I learned more from this piece about medical tribalism than about medical solutions. How can the medical profession advise and guide the public and its political representatives, if its leaders do not sing from the same hymn sheet? Let us go back to first principles and consider what a health service should provide. All medicine is acute. My medical journey starts when I realise I’ve got a problem. If I go to the hospital with it I should expect to be triaged immediately, undressed and put into a hospital gown, have my vital signs measured, and be seen by an emergency physician (note the terminology) within the time limit dictated by triage. The emergency physician will take a careful history, conduct a comprehensive physical examination, perhaps order some specific and targeted investigations, make a diagnosis and devise a management plan specific to my needs, which may or may not involve my remaining in hospital for further interventions and nursing care.
That consultation as described, is critical. Get that right, and all else may follow. Managers listen to people who are clearly on top of their game. If a powerful and effective specialty of emergency medicine says, “We need more beds”, the managers will find them.
How can emergency medicine become powerful in the NHS? The Society of Acute Medicine and the Royal College of Emergency Medicine should amalgamate.
Dr Hamish Maclaren,
1 Grays Loan, Thornhill, Stirling.
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