On bed crises and their fallout

The hospital at which I am currently working has been struggling over Christmas with the number of people coming in to A&E. Just as those tiresome leaves surprised train bosses every autumn by falling from the trees, so it always seems to surprise hospital management that more people get ill and come through the door of A&E in winter.

Unsurprisingly, the local people already know that waiting times can be bad. They know it not because of the huge waste of money that is NHS Choices, but because they actually live near it and come into it occasionally, and they mentioned long waiting times as a big problem in the survey; the hospital's response is not to look at why wait times are long, not to look at where the process could be improved - instead they just carp on about how much money they're spending on A&E (1.5m quid, if you're interested), and add the fateful "And we never close our doors to admissions."

It seems to me that this is indicative of many of the problems with the way the government and the department of health have gone about changing the NHS. There is almost never a reasoned analysis of why problems exist; those working on the frontline - doctors and nurses - are never consulted, and instead overpaid idiots dream up a way of wasting as much money as possible so they have a bigger headline figure to take to the press. That last point is what has driven government policy on the health service over the last decade - always "we are spending 10m quid on it, so it must be good", and the idea of actually engaging with and supporting the people doing the work never enters their stupid, pompous heads.

It trickles down, too - in my hospital the vogue for frittering money away on consultants resulted in management rounding up some local businessman who is doubtless very successful in the small estuary town in which he works. He came in and told us all about Toyota lean manufacturing; the upshot of this was that patients' notes were moved on some wards from a single trolley at the nurses' station to four or five small trolleys by the bays, the rationale being that they would be closer to the beds and so you would save time.

Before you read on, ask someone who works in a hospital what the commonest cause of spending time looking for notes is, or ask yourself if you work in one yourself. I'd hazard a guess whoever you spoke to said "some bastard leaving them littered around the place". The solution, therefore, is simple - either make the things electronic (difficult if you do it centrally via something like the disastrous National Programme for IT, easier but still costly to do locally) or encourage people to put the things back properly. Not easy - you need to get all the groups who take them out of their appointed slot and leave them places to stop doing so, and everyone does it - but everyone wants it to happen, so doable.

What we have instead is a system where in the past you had to look on one notes trolley plus the desk surfaces which were immediately adjacent to the notes trolley, you now have to look through five different notes trolleys dotted all around the ward, and you still have to check the desk surfaces as well. Genius. As you can imagine, management can't get enough of trumpeting this rather doubtful "best practice".

Similarly, their management of the bed crisis is stupid, although in their defence here it is governed by the unshakeable, immutable stupidity of government policy. In short, the reason that "we never close our doors" is currently that "we" are closing everything else down to create more bed space. The most recent was the closure, without any notice or consultation of staff or parents, of the on-site centre where children with complex disability get rehab. The chief exec turned up on friday and shut it; the builders moved in on monday morning.

Perhaps they thought children in wheelchairs would be less able to fight back? After all, we can't fall foul of DoH rules by saying "sorry, we're full; try somewhere else", because that would cost the trust money. Instead, we'll stop seeing 150 kids a day who desperately need this support in favour of putting 22 people with flu in the same space - and that's not even 22 people a day. The backlash, such as it is, has started, but it's hard to make these people listen.

The really ugly thing about it is that, as the staff working here, we know when we can't take on any more patients, and I'd suggest that when we've run out of beds we are probably at that point. Certainly no one would want to cut vital, careful, developmentally-crucial services to kids in favour of short-term management of illness and what must be a huge locum bill for staff who at best don't know the hospital and at worst are undertrained for the jobs they're being asked to do.

But we don't have a say in it. We just get told when to leave the building.

And in case anyone is reading who has been affected: sorry.