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Psychiatric Bulletin (2007) 31: 76. doi: 10.1192/pb.bp.31.2.76
© 2007 The Royal College of Psychiatrists
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Correspondence

Bed numbers as a limitation to acute in-patient care

Mat Kinton, Senior PolicyAnalyst

Mental Health Act Commission, 56 Hounds Gate, Nottingham NG1 6BG, email: mat.kinton{at}mhac.org.uk

Dr Middleton suggests that the Mental Health Act Commission’s criticism of acute psychiatric in-patient services in its last biennial report is a reflection of rising expectations and increased awareness of human rights, rather than an indication of any recent deterioration in such services (Psychiatric Bulletin, November 2006, 30, 404). As the principal author of the report (Mental Health Act Commission, 2006a), I am less sanguine.

Although Dr Middleton lists a number of ‘recurrent issues’ in acute care, he does not mention the key issue of bed pressures. This has an impact across many acute services, leading to ‘over-occupancy’ of beds; delayed admissions; and the use of leave for bed-management purposes; as well as disruption and distress for patients and distraction for staff. Concern over these matters has been raised with increasing urgency by many Mental Health Act commissioners over recent years, and now by the psychiatry sub-committee of the British Medical Association Central Consultants and Specialists Committee (BMA News, 2006). A recent paper on bed occupancy suggests that, over the past 2 years, certain areas in England have experienced unprecedented problems in finding beds for the admission of patients under the Mental Health Act 1983 (Mental Health Act Commission, 2006b).

Dr Middleton is surely correct to suggest that recognition of acute inpatient care as a psychiatric specialty would be unlikely to address the most pressing difficulties facing the acute inpatient sector, not least because the improvement of patient services is a matter for clinical teams (as well as hospital managers and service commissioners) and not just the nominally responsible clinician. Indeed, in some services it would appear that improvement may be reliant upon a much more fundamental question of resources: beds for the patients.

References

BMA NEWS (2006) Doctors warn of psychiatric bed shortages. BMA News, 20 October 2006.

MENTAL HEALTH ACT COMMISSION (2006a) In Place of Fear? Eleventh Biennial Report 2003-2005. TSO (The Stationery Office).

MENTAL HEALTH ACT COMMISSION (2006b) Who’s Been Sleepingin My Bed? The Incidence and Impact of Bed Over-Occupancy in the Mental Health Acute Sector. http://www.mhac.org.uk/Pages/documents/publications/who’s%20been%20sleeping%20in%20my%20bed%20-%20MHAC%20bed%20occupancy%20survey.pdf


Related articles in PB:

Bed numbers and acute in-patient care
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PB 2007 31: 233. [Full Text]  

Reasons for entering staff grade posts
Mark Fielding
PB 2007 31: 273. [Full Text]  



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