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Estimating bed occupancy

North London Forensic Service, Camlet Lodge RSU, Chase Farm Hospital, Ridgeway, Enfield EN2 8J2

Sir: Peter Greengross' recent article on the pressure on acute adult psychiatric beds was a useful attempt to quantify an important problem (Psychiatric Bulletin, February 2000, 24, 54-56). There has been little published about the experience of clinicians outside of London and this paper would appear to confirm that similar problems occur, particularly in southern regions. Such findings have implications for future resource allocation and should inform local strategic planning.

Unfortunately, the approach used, although producing a rapid overview, has disadvantages. Any survey that is reliant on postal response to questionnaires is open to response bias. The chief executive of an NHS trust when invited to comment whether beds are, ‘over-occupied’, ‘rarely, sometimes, or frequently’, is being asked to define what he or she considers is the ideal rate of bed occupancy and then give an estimate of what is occurring locally. This arbitrary estimate will, at best, follow consultation with medical records and clinicians. It may simply be a subjective estimate based on anecdote.

At a time of change in emphasis towards community-based resources, planning can only be based on reliable information. Quantification of a perceived problem can only occur with, ‘real’, data and this is best produced by a census approach as suggested by the authors. Kennedy (2000) has recommended a systemic approach to the needs assessment, involving an initial mapping of the services available to psychiatric patients, including specialist services. This would be more informative, as the pressure on acute adult psychiatric beds is likely to be related to the availability of longer stay beds, thus better informing strategic planning.

References

KENNEDY, H. (2000) Needs Assessment: Recent Advances and Toolkit. Presentation at the Residential Conference of the Royal College of Psychiatrists. Cardiff.

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