Strategic planning of acute beds by specialty

Abstract

Some of the problems facing the Health Service today have been exacerbated by inappropriate provision of beds. This paper describes a method used by one regional health authority to provide more relevant indications of likely requirements by specialty.After the NHS reorganisation in 1974 planning activity became formalised, with the advent of systems for strategic and operational planning. There is little evidence, however, that the development of new methods for planning is receiving the same attention as the development of the systems themselves. While the existence of a suitable framework may help the planning process, little progress will be made in improving the Health Service unless the plans are appropriate for the problems.Planning can be approached in two ways. The first is by in-depth studies of needs, treatment options, and outcomes, including cost benefit analyses. Such studies are essential for long-term development but at present are contributing little towards solving immediate practical problems in the distribution of resources.Alternatively, we could assume that over the next 10 years health care patterns are unlikely to deviate grossly from current practices and recent trends and, by using routinely collected statistics, we could attempt to derive simple indicators or "norms" for future requirements. Unfortunately, though based on average current practices and performances and therefore intended as broad guidelines, such norms are often taken as exact measures and remain in common use long after becoming obsolete. Despite these and other limitations this pragmatic approach is better than waiting for perfection and it was used for this study.We have concentrated on strategic planning for beds in the basic acute specialties and have excluded regional and national services. The norms for beds currently used by the Trent RHA were determined from national guidelines for total provision and were last revised about nine years ago. By restricting the scope of the work to updating these norms and creating an appropriate method for continuous monitoring we hope to have an immediate impact on medium-term developments in inpatient care. Operational planning at area and district level will require a different method, such as that described by Butts and Ashford,' which takes more account of local factors.The purpose of the study was to enable the RHA to guide area health authorities on their bed requirements, to provide guidelines for capital planning, and to help assess strategic plans. Planning must be comprehensive and the inpatient work load analyses described will be used later to determine the implications for manpower and other services. MethodThe factors affecting bed requirements can be divided into two broad types. Firstly, there are those over which the hospital service has little or no control, such as size and structure of the catchment population and the morbidity and expectations of that population. The second type depends on hospital clinical and organisational practices, such as length of st...

The Efficient Management of Medical Beds

“…The problem appears to be that no one can confidently predict the ideal number of acute beds. Previous emphasis upon bed requirements per unit population 8,9,10 has given way to a more pragmatic approach, often based on the assumed level of finances available. Yet these external constraints appear to facilitate, in ways which are by no means clear, complex changes in professional behaviour which result in a still higher turnover of patients, and more than offset the apparent reductions in facilities.…”