Hansard

I congratulate Jean Turner on securing a debate on such an important subject. Although the motion refers to the situation in the NHS Greater Glasgow and Clyde area, we are talking about a national problem. Jean Turner spoke mostly about the medical, surgical and intensive care side of things, but the problem of a lack of available beds also occurs in mental health provision.

In the Highland NHS Board area, difficulties have been experienced in finding beds for people who have acute episodes of mental illness. A knock-on effect has been that the board has had trouble staffing the hospital that deals with mental illness because junior staff, when they have been asked to do extra hours as a result of the hospital being short staffed, have refused. They have refused not because they do not like their jobs or because they are not dedicated professionals, but because they could not stand any more of the frustration of spending hours trying to find beds for patients. That is not a good use of professional time, as I know from my time as a junior casualty doctor. It is clear that the situation is much worse now and is affecting not just the acute medical and surgical sector, but the mental health sector.

Of course, some of the beds in the NHS in Scotland are where they are for historical reasons and if we were starting from scratch, we would not put them where they are now. Although those beds might not be best placed to meet the needs of the present population, if they are to be got rid of—it is probably right that some should be got rid of—the alternative must be in place before that is done.

The same principle applies to service redesign. I agree that services should be constantly redesigned, but we need to put in place the services that we are moving to before we remove the services that are currently in place. We cannot leave a gap. Too often, we see closure and promises instead of closure and alternatives. That is what worries a lot of people.

On bedblocking by elderly patients, which Jean Turner mentioned, we all have experience of that—I have professional and personal experience of it. Elderly relatives of mine have been admitted, quite rightly, to an acute medical ward after an acute episode, but have then stayed in that ward for a long time because of a lack of beds in the geriatric rehabilitation unit, to which they had to wait to be moved. Clearly, there are blockages in various parts of the system. It is not right that patients, who might be receiving good care, should continue in wards that are geared to meet not their needs but the needs of others, who are being denied that care because the bed is blocked. Bedblocking occurs within the NHS as well as between the NHS and the facilities in the community out to which people are moved.

I was attracted by the Kerr report's recommendation on community hospitals. Although that proposal was welcomed when the report was published, it does not seem to have been developed and followed up. I believe that more consideration should be given to having some kind of last stage in the rehabilitation process before the patient goes home. Once an elderly patient's acute problem has been sorted, and perhaps after the patient has had a spell in a dedicated rehabilitation unit, there would be many advantages to having a final stage of rehabilitation in the patient's community where the patient can be visited and can meet the people who will provide care and support.

One problem in the Highland NHS Board area that the minister is aware of—I feel able to mention this because Jean Turner mentioned bedblocking—is that patients are sometimes discharged to a care home outwith their local area because no place in a local care home is available and there is great pressure not to block beds. That is inappropriate for elderly people because it is disorienting and distressing. It should not happen.

The Kerr report envisaged that much more care would be provided locally, but I am not sure that that is happening. We seem to be moving to closing facilities before the full development of alternatives, which takes time. I agree that we need to try to keep people out of hospitals by better managing chronic conditions and by caring better for our elderly population. That will stop some of the acute admissions, but it will not stop them all, so we still need the beds.

I very much agree with the points in Jean Turner's motion about the capacity of the NHS to respond to an emergency. An outbreak of avian flu or human flu might place greater demands on beds during the winter months, so we cannot run a health service that is working to capacity all the time: there needs to be some slack because demand fluctuates. My concern is that we have not thought things out properly by calculating what we might need and by at least having a contingency plan. For that reason, I very much support Jean Turner's call for a national bed assessment.