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Margaret's Shoulder is not the issue

The linked story also about a shortage of Intensive Care Beds is far more important than the so called "war of Margaret's Shoulder". It, however, still does not really look at the key problems in the NHS.

Many PCTs and NHS Trusts are in financial problems (forecast deficits) at the moment. There are two main reasons for this.
  • Consultants Contracts - there is an additional cost from the new consultants contracts of about 12% the funding for which has not been provided. and
  • Payment by Results - this has not come in yet, but will result in further financial pressures which will have knock on effects.


The issue relating to the shortage of ITUs has been around for years. In part it results from the nature of the arrangements for ITUs which means that the annual cost of maintaining an ITU bed is over 250K per annum. This means that hospitals run on the edge of the numbers required. Addressing this is a matter for getting into the details of the specification to bring in higher care, but not ITU levels.

The big issues, however, relate to the financial problems from the consultants contract and payment by results. In Birmingham this is causing the local PCTs in their Local Delivery Plans to build in assumption for cuts in the numbers of beds in local hospitals. My estimate is that this could see a 20% cut over the next 5 years.

There is an argument that improvements in the mechanisms of case will result in more day care. However, using this to allow bed number cuts tied into the financial forecasts is dangerous.

These two areas need a proper, urgent and detailed review into the financial situation for the NHS. The Gershon report covers the NHS as well as other aspects of public services. However, it does not have a proper answer to this.

In essence Labour's Government is planning for a cut in frontline services in the NHS as they will be constrained by a shortage of facilities. There are already anecdotal problems through beds not being changed between patients because of the rush.

Sadly this debate will almost certainly not hit Prime Time TV as it is too complex for that medium. It is, however, the aspect of NHS planning that warrants proper consideration that it is not getting at the moment.

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