Staffed Hospital Beds (Reduction)
To ask the Scottish Government what its position is on a recent study that indicates that the reduction in staffed hospital beds in Scotland is happening at one of the fastest rates in the developed world. (S4T-00678)
Care patterns have changed over the years. More care is delivered in the community, hospital stays are shorter and there is more same-day surgery, with no need for an overnight stay, which is good for patients.
Comparing the Scottish figures with those produced by the Organisation for Economic Co-operation and Development shows that the rate of reduction in the number of beds in Scotland is slower than the United Kingdom rate of reduction. Furthermore, Scotland has more beds per head of the population than approximately half the countries that were included in the OECD analysis.
The number of staffed beds varies throughout the year to reflect service use. The most recent official statistics demonstrate that there has been an increase of 183 acute beds over the past year or so. We are not complacent. That is why we are developing an evidence-based bed-planning toolkit to ensure that we have the right number, mix and use of beds across Scotland.
The reality is that the Government’s own figures show that it has presided over a staggering decline in the number of hospital beds. When that decline is compared with the results of the OECD study, it is found to surpass the decline in nearly every other developed nation on earth.
The cabinet secretary claims that the delivery of more care in the community and shorter hospital stays have allowed the Scottish Government to reduce the number of available beds. Does he not accept that the intolerable pressure placed on the national health service and its hard-working staff, as highlighted by Dr Dewhurst earlier in the year, is a result of the decisions made by his Government, including the decision to cut thousands of staffed beds? Patients are experiencing shorter stays because someone is waiting on a trolley or in a waiting room to fill that bed.
Over the past 10 years, major developments have taken place in the national health service, which I had believed every party was signed up to. One such development was to transfer the care for mentally ill people out of hospitals and into the community as much as possible. Former health minister Andy Kerr summed up the situation beautifully when he said:
“There are good reasons for reductions in acute bed numbers:
Medical advances continue to reduce lengths of stay associated with many planned procedures, and some are now routinely carried out in a few hours without the need for any overnight stay.”—[Official Report, Written Answers, 19 March 2007; S2W-32254]
A reduction in bed numbers is a reflection of medical advance. I accept that there are some areas where there have been pressures and where the bed numbers have been reduced too quickly. In those areas, we have reinstated beds. For example, 20 beds were reinstated recently in Fife. Undoubtedly, there has been a strategic shortage of beds in Edinburgh royal infirmary because of a 20 per cent gap between the population forecast for Edinburgh when the royal infirmary was planned 10 or 12 years ago and the population levels since that forecast. Steps have been taken to rectify that strategic shortage that we inherited.
This Government has been in charge for seven years. It was only 16 months ago that, in one month alone, some 1,500 patients spent more than eight hours in accident and emergency. Does the cabinet secretary not agree that the fact that hospital beds are disappearing at a faster rate than is the case in almost every other country in the developed world is a cut too far and that the sticking-plaster approach to tackling problems in our NHS is simply not working?
As we have made clear, the problem that some people have had to wait too long in A and E after the decision has been taken to admit them is due to the flow of patients rather than any strategic shortage in bed numbers. For example, in many hospitals, the percentage of patients who are discharged on any day before noon was only 6 per cent. We have increased that rate to 25 per cent. That has allowed the patient flow to be improved dramatically. As I say, it is very often the case that such issues relate to the patient flow rather than any strategic bed shortage, and where there has been a strategic shortage, we have taken steps to address that.
After months of denial, we are seeing the extent of the pressures on NHS staff and the services that they provide fully exposed. For example, 130 beds are being blocked in this city alone. There are fewer staff, increasing demand and a social care crisis all within a system that has 6,000 fewer beds available. Will the cabinet secretary accept that we need a full independent and comprehensive NHS review to ensure that it is fully staffed and equipped to meet the needs and demands of the 21st century?
Mr Findlay wants a review because he has no policy or vision for the NHS. On the number of beds, his colleague Richard Simpson said:
“I welcome the fact that the cabinet secretary”—
that was Nicola Sturgeon at the time—
“has dropped some of the pledges that were made in the SNP’s manifesto of 2007, which were not appropriate. One example was not reducing the number of acute beds ... The cabinet secretary has now dropped that target, which is correct. If we can shift the balance of care ... it could result in a reduction in the number of acute beds.”—[Official Report, 8 June 2011; c 430.]
Labour’s spokesmen should get their act together on the issue.
It is pretty ripe to say that there is a division between Neil Findlay and me—that does not exist. The point that we are trying to make is that the spokesperson for the cabinet secretary’s party spent the two years from 2005 to 2007 attacking us for reducing bed numbers. The Scottish National Party then made a manifesto pledge in 2007 that it would not reduce bed numbers, and over the next four years it did not deal with the issue.
If we are going to have a mature debate, which I thought that we had started to do, we have to stop attacking one another on the basis of how we were before. The starting point for that is the cabinet secretary accepting that the attacks that his party made on our party when Andy Kerr was in charge were inappropriate and that the SNP’s pledge in 2007 was inappropriate. Will he do so? That is the starting point for our going on to agree on appropriate bed numbers, reflecting all the things that the cabinet secretary quite correctly talked about.
The starting point for trying to secure consensus is neither the ridiculous remarks that Neil Findlay made or an attempt to rewrite history. Let us concentrate on the future on which I think that we are all agreed, which involves shifting care into a community setting or homes. That is the future of 21st century health. It is why the number of community nurses has been increased by 30 per cent, it is why we have integration of adult health and social care, and it is why we are shifting resources into the primary care sector.
My understanding was that the Labour Party agrees with that strategy, as do the Conservatives and the Liberals. Parties cannot sign up to a strategy that shifts the emphasis into the community and then make a song and dance because of a reduction in the number of acute beds. If there are shorter stays, if mental health services are delivered in the community, and if the core of the strategy is about treating people in the community instead of in hospital, by definition we will not need the same number of acute beds. That goes without saying. People should be honest about the implications of following the strategy on which I thought we had reached a consensus.
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