Coping with winter bed crises

Editor—Hanratty and Robinson have provided some valuable suggestions for coping with winter bed crises.¹ Unfortunately, however, the title and content serve to reinforce the myth that bed crises are seasonal. Certainly, the pressures are even greater during the winter months, but many accident and emergency departments are overwhelmed throughout the year, with prolonged delays while patients await admission. Recent initiatives have produced only a marginal benefit, and the pressures on medical and nursing staff are unrelenting. Privacy and dignity for patients are lost, and the quality of care inevitably falls.

The fundamental issue is a failure to accept the impact of the volume and casemix of emergency patients on a health service that is still oriented towards government targets for elective priorities. The situation is unlikely to alter greatly until the inexorable rise is recognised and addressed by providing adequate capacity in the acute trusts. Priorities will not change so long as chief executives live under the threat of penalties for failing to meet waiting list targets and there is little incentive or reward in delivering a safe and efficient emergency service. Change must be directed from the centre without delay. The political advantages of such a strategy would be immense.