St James's Hospital annual report 1991

Abstract

The principal difficulty encountered by the hospital in 1991 as in 1990 was the shortage of acute beds. This may seem anomalous when I have just written about the commissioning of new wards. These, however, 'replaced' old wards and did not come on stream until January 1992. On any day the number of beds available may be substantially below the number required by admissions from the A & E Department. There are two consequences of this situation. Very often day beds are brought into use as full 24-hour beds to house admissions. Alternatively, patients who have booked into the hospital for some specialist treatment or surgery as in-patients may find their procedure cancelled because the beds are already full. The result is inconvenience and distress to patients and a reduction in the efficient operation of the hospital. There is no doubt that in 1991 we had less beds than are necessary to do the work of the hospital. If further proof is needed, it lies in the activity data which shows an overall bed occupancy for the hospital of 93.6% in 1991, with many medical and surgical wards showing 96% and 94% occupancy (see p. 4). It would be generally agreed that an occupancy of around 85% is about the optimum. Needless to say, the staff and Board of the hospital are continually seeking means of improving or increasing bed numbers and bed availability. In this Report I wish to make a special mention of nursing and nurse education. The workload of the hospital bears heavily on nurses and ward sisters. They, nevertheless, maintain high standards of care. With the development of hospital specialties, whether they are high or low-tech in character, the nursing required becomes increasingly specialised. Nurses with special skills are scarce and can be employed almost anywhere in the world. The Nursing School has plumed and introduced a suite of post-basic or post-registration courses in "Care of the Elderly", "Theatre Nursing" and "Critical Care Nursing". A course has also been provided on the care of patients with HIY. No doubt some of the nurses receiving these courses will work elsewhere but some will stay at home and ensure that our specialist services have the required nursing skills.