Jun 06 2007
Why is there a shortage of hospital beds but not of hotel beds?
Choice and competition works. Monopoly doesn’t.
In recent years we have been short of hospital beds, despite the huge increases in health spending. Some people have had to wait for a year or more to get a bed in hospital for a few days so they can have an operation.
I cannot remember us ever being short of hotel beds. If??you needed a bed for the night in London or Wokingham tonight I could ring up and book one. Indeed??you would have a wide choice of different styles and prices, whether you were payting or someone was paying for you.
The difference is one is supplied by a government monopoly, the other by free enterprise.
??I have sympathy with the consultants in criticising the crass political interventions made by this government into the NHS, and agree that some??of the?? decisions about cuts have been ill judged. However??it is not good news that staff in the NHS enter such public spats with their employer, fueling the story that the "NHS is on its knees". The Parliamentary Opposition may today be grateful that staff share some of our analysis, but would be unwise to fuel confrontation between doctors and government as that just helps make the NHS even more unmanageable.
John Redwood has been the Member of Parliament for Wokingham since 1987. First attending Kent College, Canterbury, he graduated from Magdalen College...
Dear Mr Redwood
Did you see the Gerry Robinson programmes some while back about the management of Rotherham Hospital? I did and it seemed to me that most things were in place to do the job properly - buildings, equipment, trained staff, funding etc - but the whole thing was a bit of a shambles because of the management, both structure and people. It was chaotic.
On a more general point, it seems to me that the one word to sum up Nulab in action (if that is the correct word)is “incompetence”; they do not have anyone capable of organising the proverbial party in a brewery.
The question is; can the tories do better? I am sure you will promise to do better but, after the grammar schools fiasco, have the tories actually got people capable of running big operations?
Finally, have you been able to get down to the detail of planning to simplify working methods for the police, teachers, doctors and nurses etc, ready to introduce within the first 100 days or so of a tory government?
Best wishes
David Belchamber
There is a shortage of beds because beds have been closed because it has been argued that treatments have changed, day surgery is now far more common and hospital stays are shorter. All true. But the other reason is that it is more efficient to have a 98% occupancy than an 80% occupancy (accountants definition of efficiency). However, a 98% occupancy does not allow for the flexibility needed to cope with the unexpected - and the unexpected is commonplace in health care - hence the bed shortage.
Have you tried getting an affordable room (i.e. one that you can afford to live in for a month whilst on a lowish wage) for the night in Central London during the summer? It’s not quite that easy you know. I think it’s a bad analogy, if you can afford to go private you can get a hospital bed as easy as you can a hotel room when you have platinum card.
The worst thing with the NHS is that it is starting to looks like your voting intentions are taken into account when they decide what level of treatment to offer you. Labour have ended the post-code lottery and seem to have replaced it with a politicised system of reward, bribery and punishment based on how your neighbour’s vote.
I’m toying with the idea it should be privatised to end this madness, but I’m put off by both the logistics of doing it and the fact that the USA, despite having the highest standards at the top-end of the market, has statistically the most inefficient health service in the developed world.
I have seen how many hospital beds we had in 1964….then in 1979….then how few we had by 1990. Someone during the Thatcher years had the brilliant idea that an ageing population meant we could not afford pensions but that these ageing pensioners would not need hospital beds either…..so they got rid of a couple of hundred thousand.
If you recall how we ad around 800.000 in the 1960s and now have around 250.000 or fewer you can see just how busy our politicians have been. Credit where credit is due, Labour has been a shambles but the Conservatives have form
Oh I was behind the times
1984 we had 211,617 hospital beds
1990 we had 176,860
1995 we had 153,982
1997 we had 148,828
2004 we had 145,218
Funnily enough over that period we halved Maternity Beds from 17,198 to 9,095 (DoH Stats)
In 1959 this says we had 245,000 hospital beds. There were also reserve beds in the Civil Defence system in Northern England in the event of nuclear attack
We have of course increased bed-occupancy to near 100% which makes it hard to disinfect patients or wards properly and little problems like MRSA are evident
These figures are for “staffed” hospital beds and this peaked in 1960 at 250.000. The ageing population meant 60% admissions were now emergencies which means beds are no longer available for routine surgery cases
Great analogy. Of course what Steven L doesn’t ask is why are people on lowish wages taxed at all? We define someone as in poverty if they are on 60% of the average wage, surely it makes no sense at all to tax them and make them poorer still!
If they weren’t taxed so heavily, then they would have more of their own money, and most likely COULD afford at hotel room or a hospital bed. Incidentally, I did a quick search for the cost of health insurance for a non-smoking middle-age male like me. The most I could spend for the top package was about
We do have a shortage of Hotel beds John, if you’d be a little less disingenuous about your compassion. Health services are provided on the basis of need. There are a lot of people that need houses and accommodation, but can’t get it, just as there are a lot of people who need medical treatment and can’t… the common factor being that those who can afford to pay for both refuse to pay for either.
Analogies are rather mischievously drawn when one compares goods supplied because we decide politically that need must be fulfilled, and those supplied on the basis of market demand; i.e. to those who can afford to pay for the cost demanded by the seller; especially where the resources required for production are naturally limited (for example in drug synthesis as opposed to the simple clean sheets required in hotels) and one can more easily establish productive monopolies (in this respect, producer interest is hardly limited to employees, is it?).
Wherever one based supply on the criterion of ability to pay, some cannot; hence shortage. Whenever one provides a good and revenue is required, the good may be supplied only if the necessary revenue is supplied.
So the key to eradicating shortage is making sure whatever good we are providing, whoever is providing it, is paid the net cost of production and supply.
The moral and political question based thereupon is exactly who should pay, how and why. These means are, at a rather abstract level I confess, rather unrelated to the ends, save for that which I point out above.
The difference between my political party and yours is that you prefer poor people to pay, and only those which can; and distribute good accordingly. We prefer, as opposed to those who can, those who should pay, to do so.
It’s not about supporting the people against shortage. It’s simply a matter of which people you think should make up for it.
This is something of which I am quite confident you are aware.
“disingenuous about your compassion”
Compassion there being intended to be ‘comparison’. I mean this honestly: on the public face of things, at least, you are the last figure on this planet whom I would associate with such a glowing term of human endorsement.
There is a lot you could learn from Michael Portillo, sir.
‘Of course what Steven L doesn’t ask is why are people on lowish wages taxed at all?’ (Stuart Fairney)
Oh, believe me, I’ve asked this question many times, perhaps not here, but I’d be preaching to the converted on the merits of lower taxation.
‘Those who say hotel beds are dear in London are ignoring how dear the NHS is.’ (John Redwood)
Now come along, I’m not ignoring anything, health and education are very difficult subjects for the average person to get their heads around. I’m 27 years old with no kids and healthy, I get private health insurance through my employer for next to nothing. The very reason I’ve read all the various wikipedia pages on healthcare in the developed world and compared the costs and benefits is precisely because I am not ignoring the issue. I just can’t honestly say I know the answer. The USA seems to spend an awful lot of their cash on healthcare compared to Europe. It would be interesting to see someone with more time that I have actually make a professional comparison of the US education/healthcare system and taxation to the UK/European model. I don’t pretend I am the man to do this, and talk of NHS privatisation just turns people off. I saw that author get hissed on Question Time the other week for suggesting the idea and read a bit further into it, end of.