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 Inside Out - East: Monday June 16, 2003

WHY ARE WE WAITING? - HOSPITAL BEDS

Hospital montage
Nick Lawrence takes on the role of bed manager

NHS waiting lists - the subject of great lamenting and endless complaints. Think you could do a better job organising hospital beds? Radio presenter Nick Lawrence does. Join Inside Out as we put him to the test.

Bed manager Kyra Shade plays a vital role in the smooth running of Bedford Hospital. But with over 5,000 people on the waiting list and only 380 beds available - her job is not an easy one.

As presenter of BBC Three Counties Radio breakfast show, Nick should be fairly used to the early starts, but taking over Kyra's 12 and a half hour shift is another matter!

Nick joins the shift just as 10 beds become free. Kyra assures us this is not the norm.

Even with such high availability, Kyra could have up to 40 accident and emergency patients arriving as well as the scheduled operations - so no fear of those beds remaining empty for long!

Kyra Shade on the phone
Kyra is alerted to bed changes via a pager. She phones to find out more

Lo-tech

The complex juggling act that Kyra performs each day across 20 wards is all recorded on a single sheet of paper - not a computer in sight.

Nick is quick to highlight how this inefficient way of working makes Kyra's job much harder.

Not one to keep quiet, Nick takes his observations to a top level management meeting.

Divisional Manager Patricia Miller is only too aware of the issues.

"To modernise you need to be able to step back from it, which takes time," says Patricia.

"If you're going to get banged on the head for not meeting targets, but no one's really going to give you grief for not modernising, you concentrate on the targets."

The hospital is already keeping open an extra 23 unfunded beds, eating further into the already shrinking budget.

This and the ever growing targets mean that the new equipment Kyra needs to modernise her job is still unavailable.

Nick in front of a white board
Kyra relies on pen, paper and white boards to track vacant beds

Another way?

Modernising the job of bed manager is not an option so Nick turns to hospital workers for advice.

The answers are unanimous. To reduce the waiting lists for beds, the hospital needs more money, more doctors and more nurses - and according to the hospital Imam - divine intervention.

Nick has ideas too.

Freeing up beds is the key to shrinking waiting lists. Often patients who are well enough to go home are kept waiting in valuable beds until a consultant becomes available to discharge them.

Giving nurses and junior doctors the power to discharge would result in a faster turnaround of beds - a point Nick puts to Consultant Surgeon Michael Callum.

"There are discharge protocols to allow nurses or junior doctors to discharge," explains Michael.

"But in some cases the case may be too complex and needs the consultant to make that decision."

Nick Lawrence on a hospital bed
Nick may be in need of a bed himself by the end of the day

Culture shock

As with rest of the NHS it seems there is no easy solution to streamlining the duties of the bed manager.

While doctors, nurses and hospital staff continue to work to maximum capacity, changes to improve working practices are slow to be implemented.

There is ever increasing pressure to reach targets - waiting lists in this hospital alone have been cut from 47 weeks to 21.

"The NHS is going through the biggest culture change any organisation has ever been through," says Patricia Miller.

So while Nick rests his legs and resigns himself to the fact that improvements are some way off yet, Kyra picks her pen and paper and gets back on the wards - it's business as usual.

See also ...

On bbc.co.uk
BBC: Health - Q&A NHS waiting lists

On the rest of the web
Guardian Unlimited: Hospital waiting lists 'on target'
Bedford Hospital
NHS
Hospital waiting times
Department of Health

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