Turning round NHS deficits

Editor—Ham's editorial is a clear summary of the NHS's current financial plight.¹ However, in his fourth paragraph he illustrates a gulf between health economic and medical thinking.

There seems to be a specific belief in health economic circles that there is overprovision of beds in acute hospital settings. As a doctor I do not share this belief.

When I admit acutely ill patients I see no evidence of oversupply of acute beds. Instead I am often asked to delay the admission or deflect it to the accident and emergency department first. The psychiatrist tells me that he can admit patients only if they are homicidal or suicidal. The phenomenon known as bed blocking does not speak of overprovision of care in hospital, intermediate, or residential care settings.

All these examples speak of lack. I challenge Ham to show me which patient specifically is currently being overprovided for in any NHS bed.

Roemer's law of demand, that a bed created is a bed filled, is a reflection of the fact that there is still much unmet need for healthcare. One of the commonest research findings is that this disease is undertreated or diagnosed in primary or secondary care and more time, money, and education should be put into it. This unmet need is a consequence of the icebergs of symptoms and disease.²,³

The NHS should be gearing up to meet unmet need. Instead it is currently being downsized and fragmented, whilst expectations of it are being upsized. The attempt by the government to sustain it solely from taxation is falling apart. In 2002 I asked what exactly would be bought by increased NHS funding.⁴ In 2006 we can see that little has been bought, and much wasted.