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NHS managers meet over beds crisis

John Watkinson, chief executive of the King's Mill Centre for Healthcare Services NHS Trust and conference chairman, spoke of the need for better liaison between general practitioners and hospital doctors. He said: "The problem manifests itself at the point of admission to hospital, but it cannot be solved by hospitals alone. It relies on hospitals working with the primary sector and the community and also on cooperation between purchasers and providers to balance supply and demand all year round."

Inappropriate use of beds, difficulty in recruiting medical and nursing staff, and the growing numbers of elderly people, are seen by senior NHS managers as major problems. Care in the community is also a contributory factor.

Dr Ellie O'Sullivan, medical director of Richmond, Twickenham and Roehampton Healthcare NHS Trust, spoke of the "siege mentality" created by the NHS internal market, which engendered competition and fragmentation among neighbouring trusts.

The conference heard that specialised discharge wards, in conjunction with admissions wards, helped to ease blockages. Mr David Ferguson, medical director of Central Sheffield University Hospitals NHS Trust, said that admissions wards were an expansion valve and should not be seen as an excuse to cut beds in other wards. They should be staffed by specialists including consultants, who should discuss admissions with patients' general practitioners.

Mr Ferguson said: "Discharge starts the moment you cross the threshold of a hospital. You don't wait until the point of discharge before you realise that a patient can't go home because he needs a stair lift. We have to get our act together much earlier in the process and find out whether a patient whom we are admitting is going to need aftercare."

Conference chairman John Watkinson said that the meeting had passed no binding resolutions. He predicted, however, that the conclusions reached would form the basis of many trusts' responses to the next executive letter to be issued on the matter by the health department.--OWEN DYER, freelance journalist, London

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