Concern has been growing for months over the practice of hospital “boarding” – moving patients between wards and parking them in wards that are not appropriate for their condition.
Worries have centred on the impact of switching on elderly patients and their additional exposure to hospital infections.
The rationale for such a practice is that it is necessary to free up space in acute emergency units that increasingly find themselves filled to overflowing. But patients resent it, hospital staff do not like it and administrators are far from enthusiastic, describing it as a necessary evil, forced upon them by increasing pressures on hospital space.
Now comes an authoritative study showing that moving patients between wards may be self-defeating, increasing the risk of spreading infection and resulting in patients having to stay in hospital longer. Pressure on bed space, far from being relieved, could be intensified by the practice.
The study finds that a reduction in bed numbers, combined with an increase in hospital admissions has led to boarding becoming increasingly common, especially among older patients. And far from being a necessary evil which relieved pressure on hospitals, it looks more like a false economy, leading to patients having to remain in hospital for longer periods than would otherwise be the case. Elderly patients in particular are least able to cope with the risks posed by resort to boarding. Tellingly, a survey of medical staff shows that 92 per cent of doctors would “refuse to have a relative of theirs boarded out”.
Action cannot come soon enough. There is no escaping the fact that long-term solutions are going to be needed. There is an evident insufficiency of properly-supported acute bends in Scottish hospitals to ensure patients are treated in the right wards by the right medical staff and at the right time. Pressure is certain to increase as the result of demographic factors and the increase in the elderly population.
But there is also pressure to find ways of relieving this problem in the interim. Dr Neil Dewhurst, president of the Royal College of Physicians of Edinburgh, said yesterday it would fully back calls to reduce unnecessary ward moves, especially for the elderly, and that he will be working with the Scottish Government to address the problem and develop guidance for the NHS in Scotland, which should be available later this year.
There is more that NHS boards can do to ensure their capacity is being most effectively managed. And there is much that visual technology could usefully bring to support real-time decision-making at ward level, helping clinical staff to track the progress of patients from admission, through treatment to discharge.
Every effort should be made to put in hand changes that would reduce the incidence of boarding, for the health and comfort of frail and vulnerable patients and for the hospitals themselves. Addressing the problem by making it worse is no solution at all.
Energy customers still in the dark
In an age that champions consumer protection and greater accountability, few artefacts in modern life today present a greater riddle for millions of households than their energy bills.
Even more unfathomable are the accounting practices by which the energy companies arrive at their profits. MPs have thus good reason to take up the cause of consumers. Westminster’s energy and climate change committee has taken the energy regulator Ofgem to task for not taking enough action to tackle the problem and restore consumer confidence.
MPs’ recommendations include making bills simpler to understand and for prices to be compared with those of other companies. There were “serious shortfalls” in the way energy companies communicated with customers. Poor communication on why energy prices have gone up has resulted in “deep mistrust” among customers. And the small incidence of people switching suppliers suggests the market was not as competitive as it could be.
This is all very laudable, for it is hard to disagree with the brutal summation of Adam Scorer, policy director at Consumer Futures, that consumers have been faced with massive increases in bills since 2007, but despite numerous reviews and reforms in the energy market, “both the behaviour of firms and the policy framework have failed to address the consequences of higher prices and a fundamental lack of consumer trust”. Parliament needs to keep “on the case” and Ofgem needs to be continually reminded of the imperative that energy bills must be clear and comprehensible.
Recommendations are welcome. But what customers are desperate to see is these recommendations carried into practice.