The number of cancelled elective operations rose to record levels last year in NHS hospitals in England. In 1998-9 more than 56000 NHS operations were cancelled on the day they were due to go ahead—an increase of 12% over the previous 12 months—according to a report from the independent National Audit Office (NAO).
The report shows that hospitals also failed to treat over 9000 patients within one month of their cancelled operation. This was 29%more than in the year before. Twenty per cent of patients waited longer for emergency treatment than the two hour limit laid down by the patient's charter, and 35%of hospitals faced a beds crisis at least once a day.
Operations were cancelled because there were no inpatient beds available, there was no theatre time available, or there was a shortage of staff and equipment. The report found that cancellation rates varied widely around the country. The admission of emergencies was the most commonly given reason, and the position was worst between January and March. The National Audit Office blames poor information systems for much of the problem.
It found that few hospitals had systems providing up to the minute information to monitor and coordinate beds and theatre time and that in 90%of trusts bed managers obtained information about bed availability by personal inspection or telephoning wards several times a day. Although the audit office found that many hospitals were making considerable efforts, it recommends making better use of bed managers to avoid crisis management; increasing communication between doctors, nurses, and managers; assessing patients before they are admitted; and talking to other organisations earlier about discharging patients.
The head of the National Audit Office, Sir John Bourn, said: “This winter has reminded us again of how crucial it is that hospitals manage their bed stock effectively. Failing to place patients promptly in the most appropriate facilities, cancelling their admissions, or delaying their discharge from hospital can cause enormous frustration and distress.”
Mr David Davis MP, chairman of the House of Commons public accounts committee, which will take evidence on the report next month, said that the findings were “symptomatic of poor bed management.”
John Lister, from the pressure group London Health Emergency, said, “This underlines the conclusion of the national beds inquiry—that the last government and this one … have allowed bed reduction to get to such a level that the NHS cannot sustain the service.”
Inpatient Admissions and Bed Management in NHS Acute Hospitals is available from the Stationery Office, price £13.10, and on the National Audit Office's home page (www.nao.gov.uk).
Figure.
Cancellations of operations peak in the last quarter of the financial year
Figure.
The number of hospital beds fell by 6%between 1993 and 1998